Until Recently, there have not been qualitative, conclusive "studies" verifying the benefits of wearing a Flu mask to help protect against the many types of Flu viruses that routinely occur every year. The following information includes recent scientific studies, published findings & information from the scientific community that provide conclusive evidence of the protection a Flu Mask can provide in helping to protect against Swine Flu (H1N1) and other types of flu viruses, particularly when coupled with good hygiene practices.

VOA News 28 April 2009
Australian Researchers: Surgical Face Masks Important Weapon Against Swine Flu
In what Australian researchers say is a world-first clinical trial, surgical masks have been found to be a cheap and effective front-line weapon against epidemics such as swine and avian flu. A team at the University of New South Wales says masks have an important role to play especially when vaccines are unavailable. Study provides scientific evidence Australian researchers say their trial provides the first scientific evidence that surgical masks greatly reduce the risk of contracting contagious respiratory illnesses, including swine flu or even the common cold.  The study commissioned by the Australian Department of Health and Aging analyzed the effect that close contact with sick children had on about 300 adults. The research team was led by Raina MacIntyre, a professor of Infectious Diseases Epidemiology at the University of New South Wales. She says the results show that surgical face masks have an important part to play in protecting public health. "They do show that there is clinical effectiveness of masks and that if a pandemic were to take off that masks are a potentially effective way of preventing transmission and, you know, right now we do not have a matched vaccine. It will take a minimum of eight weeks - possibly up to 12 weeks - before we have a matched vaccine," MacIntyre said.  "And (in) that period we need to look at all available, other measures to prevent the transmission of influenza." How does virus spread? Experts say that the new H1N1 swine flu virus is spread the same way as the other forms of the disease - through sneezes and coughs and by touching contaminated surfaces.The Australian study pointed out that while there has been strong public acceptance of surgical masks across Asia, less than half the Australians who participated in the trial kept their masks on despite being exposed to sick children. Other research has shown that few hospital doctors and nurses in Australia wear such protection at work. A larger study into the effectiveness of face masks has been carried out in China and results will be published shortly. In Mexico, where the swine flu first appeared, it is believed to have caused the deaths of more than 100 people. Cases have since been found in the United States, Canada and Europe. No cases of swine flu have been confirmed in Australia, but there are about 20 suspected cases spread throughout the eastern states of New South Wales, Queensland and Tasmania.

Worried About the Flu? Get a Mask
Scientific American, January 26th, 2009
You can cut your risk of contracting the flu or other respiratory viruses by as much as 80 percent by wearing a mask over your nose and mouth, according to a new study.
"This is the first clinical trial to show a positive effect of masks on preventing the transmission of respiratory viruses," says Raina MacIntyre, an epidemiologist and head of the School of Public Health and Community Medicine at the University of New South Wales in Sydney, Australia, and lead author of the study published today in Emerging Infectious Diseases, the journal of the Centers for Disease Control and Prevention (CDC) .
The U.S. has been stockpiling face masks to distribute to people in the event of a deadly bird flu or other viral outbreak, but MacIntyre says that until now clinical evidence that they're effective has been thin. She says this study shows they could limit the spread, which is crucial given that it could take up to six months for scientists to roll out vaccines and drugs targeting the responsible virus. 
During the winters of 2006 and 2007, MacIntyre and her team tested the effectiveness of masks on 286 adults (mosty parents) in 143 households in Australia. They split participants into three groups: one in which participants wore surgical masks (used in hospitals), another in which members wore a mask known as a P2 that's specially designed to filter out water droplets containing viruses, and, finally, one in which subjects did not don cover-ups.
All of the participants were initially healthy but at risk for catching viruses from their children, who had documented cases of respiratory illness. The researchers found that, after a week, the non-mask wearers were four times more likely to catch a variety of viruses, including the common cold and flu, than those who wore them properly (meaning they strapped them on whenever they happened to be in the same room as their sick children). The masks appeared to be equally effective.
The U.S. has already stockpiled 51,794, 600 surgical masks and 105,873,370 N-95 masks (similar to the P2 variety used in the study), according to CDC spokesperson Von Roebuck. He notes that each state has its own supply, which the feds will augment if necessary.
For those of you who are interested, surgical masks (made of paper) can be purchased at most local pharmacies for less than a buck, while N-95's (a paper/fabric combination) are available at pharmacies or online for as little as six dollars a pop.
Recent reports underscore the fact that avian flu, the bird virus that could potentially mutate to cause a major epidemic in humans, is an ongoing threat. Just today, China announced the H5N1 strain of avain flu claimed its fifth victim there this month -- an 18-year-old man in the southwestern Guangxi province, according to Reuters.

Published Oct. 28, 2008, Medical Research News; Landmark Study by the University of Michigan: “Protect yourself by wearing a Flu Mask and washing your hands”.
In what has been termed a landmark new study, it is suggested that wearing masks and washing hands prevents the spread of flu-like symptoms. While this may seem to many to be a case of the blatantly obvious, the study is apparently a "first-of-its-kind" examination of the effectiveness of non-pharmaceutical interventions in controlling the spread of the flu virus in a community. The researchers at the University of Michigan School of Public Health say wearing masks and using alcohol-based hand sanitizers may prevent the spread of flu symptoms by as much as 50%. The research team carried out a study called M-Flu on more than 1,000 students from seven U-M residence halls during last year's flu season and they found that mask use and alcohol-based hand sanitizers helped reduced flu-like illness rates from 10 to 50% over the study period. Assistant Professor of epidemiology Allison Aiello says even though the initial results are encouraging, the first year of the two-year project was a very mild flu season and only a few cases were positive for flu, so results should be interpreted cautiously. Professor Aiello, co-principal investigator, says masks and hand hygiene may be effective for preventing a range of respiratory illnesses and ongoing studies will test for other viruses that may be responsible for the influenza-like illness symptoms seen. At the start of flu season in the last two years, participants were randomly assigned to six weeks of wearing a standard medical procedure mask alone, mask use and hand sanitizer use, or a control group with no intervention. The researchers monitored the students for incidence of flu-like illness symptoms, defined as cough with at least one other characteristic symptom such as fever, chills or body aches. Professor Arnold Monto also a principal investigator on the study, says from the third week on, both the mask only and mask/hand sanitizer interventions showed a significant reduction in the rate of influenza-like illness symptoms in comparison to the control group, which remained even after adjustments were made for gender, race/ethnicity, hand washing practices, sleep quality, and flu vaccination. The researchers say in the event of a pandemic flu outbreak, non-pharmaceutical interventions such as hand washing and masks, may be critical as pharmaceutical interventions such as vaccinations and antivirals may not be available in sufficient quantity for preventing and controlling the outbreak. Last year the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services along with others developed an interim planning guide on the use of non-pharmaceutical interventions (NPIs) to mitigate an influenza pandemic. The measures include voluntary home quarantine, isolation and treatment of cases, social distancing, personal protection such as face masks and hand hygiene, and school dismissal and Monto says many of these measures are difficult or impossible to evaluate in advance of a pandemic. However, he says the use of face masks and hand hygiene interventions can be evaluated now, during seasonal influenza outbreaks, which can provide concrete evidence for decision makers. The researchers say more research is needed to confirm whether mask use may be an effective means of reducing influenza in shared living settings as it was not possible to blind subjects and knowledge of the intervention may have influenced influenza-like symptom reporting - therefore the results of this study should be interpreted with caution. Aiello says during year two of the study (2007-2008) a major outbreak of influenza took place, and upcoming studies will examine whether results observed during this more severe outbreak mirrored those observed during the milder year one influenza season. The findings were presented at The Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America annual meeting in Washington, D.C.this week.

Science Daily (Jan. 26, 2009) www.sciencedaily.com: "Donning a flu face mask is an easy way to boost protection from severe respiratory illnesses such as influenza and SARS, new research from the University of New South Wales (UNSW) has found ... but convincing a reluctant public and health workers is proving a struggle"
In a world-first clinical trial of the efficacy of masks, researchers found adult mask wearers in the home were four times more likely than non-wearers to be protected against respiratory viruses (such as Swine Flu), including the common cold. The findings published recently in Emerging Infectious Diseases, the journal of the US Center for Disease Control and Prevention have global implications and are particularly relevant to efforts to combat the spread of flu pandemics and other emerging respiratory diseases such as SARS. "In the event of a severe pandemic, demand for protection could become a law and order issue," said lead author of the paper, Raina MacIntyre, who is Professor of Infectious Diseases Epidemiology and head of UNSW's School of Public Health and Community Medicine. "In a crisis, vaccine development is likely to be delayed and drugs may be in short supply or not available at all," she said. "Limited supplies will be directed first to front line health workers, so having a flu mask on hand is an important means of protection for the community, who otherwise may be last in line for vaccines and drugs." While some governments are already stockpiling flu masks for use in emergencies, Professor MacIntyre said these guidelines had previously been implemented without evidence to support them. "We now have provided that evidence. Wearing a Flu Mask plays an important role in reducing transmission if they are worn properly." "There is no effective treatment for the 90 or so common cold viruses that make families sick each winter, but a face mask can provide simple and effective protection," Professor MacIntyre said. Commissioned and funded by the Australian Department of Health and Aging in response to an urgent policy need, the study is the first randomized controlled clinical trial of flu masks to be conducted internationally. Researchers at UNSW, Sydney's Westmead Hospital, Imperial College (London) and the National Centre for Immunisation Research studied more than 280 adults in 143 families in Sydney during the winter seasons of 2006 and 2007.

You can cut your risk of contracting the flu or other respiratory viruses by as much as 80 percent by wearing a mask over your nose and mouth, according to a new study. "This is the first clinical trial to show a positive effect of masks on preventing the transmission of respiratory viruses," says Raina MacIntyre, an epidemiologist and head of the School of Public Health and Community Medicine at the University of New South Wales in Sydney, Australia, and lead author of the study published today in Emerging Infectious Diseases, the journal of the Center for Disease Control and Prevention (CDC). The U.S. has been stockpiling face masks to distribute to people in the event of a deadly bird flu, swine flu or other viral outbreak, but MacIntyre says that until now clinical evidence that they're effective has been thin. She says this study shows they could limit the spread, which is crucial given that it could take up to six months for scientists to roll out vaccines and drugs targeting the responsible virus. During the winters of 2006 and 2007, MacIntyre and her team tested the effectiveness of masks on 286 adults (mosty parents) in 143 households in Australia. They split participants into three groups: one in which participants wore surgical masks (used in hospitals), another in which members wore a mask known as a P2 that's specially designed to filter out water droplets containing viruses, and, finally, one in which subjects did not don cover-ups. All of the participants were initially healthy but at risk for catching viruses from their children, who had documented cases of respiratory illness. The researchers found that, after a week, the non-mask wearers were four times more likely to catch a variety of viruses, including the common cold and flu, than those who wore them properly (meaning they strapped them on whenever they happened to be in the same room as their sick children). The masks appeared to be equally effective. The U.S. has already stockpiled 51,794, 600 surgical masks and 105,873,370 N-95 masks (similar to the P2 variety used in the study), according to CDC spokesperson Von Roebuck. He notes that each state has its own supply, which the feds will augment if necessary.

Reprinted from Michigan Today (2009)
Allison Aiello: The overall objective of the M-FLU Study was to investigate the feasibility and effectiveness of using non-pharmaceutical interventions, specifically masks and hand hygiene, to prevent the transmission of influenza in residence hall units at the University of Michigan. The study separated students into two groups. One wore masks and washed hands regularly. The other used masks alone. We conducted a cluster randomized intervention trial among University of Michigan students living in university residence halls. Students were randomized into one of two intervention groups (face masks with hand hygiene; face masks alone) or a comparison (control) group. Interventions were carried out over two periods of seasonal influenza transmission (2006-2007; 2007-2008) for a six week study period. Students completed electronic surveys, reporting their health behaviors, use of the interventions (if applicable), and occurrence of influenza-like illnesses. In all selected residence halls, when illness symptoms met the criteria for influenza-like illness, specimens were collected for viral isolation. What conclusions do you draw from the study that would be relevant to the current outbreak of swine flu—or future outbreaks of other strains? The M-FLU study demonstrated that mask use and hand hygiene (alcohol based hand sanitizer) among university students was associated with a significant reduction in the rate of influenza-like illness of up to 50-65% over the six-week intervention periods. Our study utilized a unique design by asking participants to begin wearing a mask and use hand sanitizer every day at the very beginning of the influenza season, just after the first case of influenza was identified on campus. This design is in contrast with household study designs that have examined the effect of mask use on secondary transmission where household members may already have been infected by the time mask use was implemented. The study suggests that masks plus handwashing are most effective when their use is started at the first sign of outbreak—before the flu spreads. Thus, our study provides evidence that application of masks and hand hygiene interventions prior to outbreak conditions can mitigate transmission of respiratory illness in shared living settings, such as university dorms. Because there is little or no immunity in the human population against the novel 2009 H1N1 virus and there are currently no available vaccinations, the government has been primarily focusing on non-pharmaceutical mitigation measures to reduce transmission. For this reason, non-pharmaceutical interventions (NPIs) represent our best defense against mitigating 2009 H1N1 transmission in the US.

"Do Masks Really Make A Difference?" A study conducted in the laboratory setting by vander Sande et al. assessed transmission reduction potential provided by personal respirators, surgical masks and homemade masks.
Masks were worn by healthy volunteers and a simulated patient during various activities. All studied masks reduced aerosol exposure, but with a high degree of individual variation. Children were less well protected, regardless of mask type. The researchers concluded that any type of general mask use is likely to decrease viral exposure and infection risk on a population level. In a laboratory study conducted by Fabian et al., influenza virus nucleic acid was present in fine particle aerosols from influenza patients, in both tidal breathing (14-33%) and coughing (64%). Preliminary results suggest that wearing a face mask can limit the generation of influenza virus RNA contained in large droplets. Investigation of the efficacy of face masks to limit the generation of fine droplets virus particles is ongoing. Our study did not support a significant reduction in influenza-like illness with masks only. The mask and hand hygiene groups showed the greatest reduction in influenza-like illness, suggesting that a combination of the mitigation measures may work best at reducing transmission. However, it is unclear whether the protection is related to reduction in aerosol fine particle droplet nuclei or reduction in contact transmission due to less contact of hands with nose and mouth while the masks were being worn by participants. What would be key events in this or future flu epidemics that you think should trigger new actions or behaviors by ordinary people? At what point, for instance, would you suggest people begin wearing masks when they go out in public? Sustained human-to-human transmission of disease represents a key feature necessitating behavioral change. The key to mitigation of an influenza pandemic is adequate surveillance of disease transmission, early implementation of protective measures (i.e., face masks, hand hygiene, school closures, social distancing, quarantine, isolation) in affected communities, and travel restrictions. Individuals should follow the current recommendations of the CDC, and recognize that peaks of pandemic activity may occur in multiple waves spread over months. There are many gaps in current pandemic influenza knowledge and effectiveness of mitigation practices. The 2009 H1N1 influenza outbreak may provide a critical window to address many of the gaps in research regarding social behavioral response to outbreaks, compliance with NPIs, and effectiveness of NPIs. Support of additional research is essential. Currently, plans have been developed which describe what needs to occur in the event of pandemic influenza, but they fall short of detailing how to carry out the recommendations. Policy makers must develop consistent laws specifying the authority of public health officials to implement NPI measures across county, state, or national jurisdictions and the responsibility of the federal government in terms of economic compensation for individuals, in the event of compulsory NPI measures which results in lost wages, such as staying home from work.

ABC, March 31, 2008: "Even cheap masks stop flu from spreading"
Normal surgical masks help prevent people with the flu from spreading the virus just as well as more expensive face protection, a study shows for the first time. Australian researchers found that in a real-life situation surgical masks effectively contain the virus when infected people cough. Previous studies tested masks in laboratories using machines, not humans, and with non-infectious particles, says co-author Professor Lindsay Grayson, director of infectious diseases at Melbourne's Austin Hospital. "Our study compared the value of masks for the first time in a real-life clinical situation, in people with flu," Grayson says. Fellow researcher, infectious diseases registrar Dr Doug Johnson, will present findings at the Australasian Society for Infectious Diseases annual scientific meeting on the Sunshine Coast this week. The study compared routine surgical masks with the more expensive and uncomfortable N95 masks, which are made from finer material. Johnson recruited 28 people who presented to emergency with suspected flu; nine with confirmed influenza A or B continued in the study. Most arrived about two days into the illness at their sickest and most contagious. Participants coughed onto Petri dishes wearing no mask, a surgical mask and an N95 mask. Dishes were 10 centimetres away, about the same as lying near a coughing person or a sick child coughing into a parent's face. Both masks work. No influenza virus was detected when participants wore the surgical or N95 mask but influenza was detected on all dishes when no mask was worn. "Using this method, both masks appear to work equally as well because there was no detectable virus on the dishes. The material of both masks stopped droplets escaping," Grayson says. "Although small, this study suggests that it doesn't matter whether people with flu wear a surgical or N95 mask, it's likely to prevent transmission of the virus, meaning less infection of healthcare workers and relatives. "We can apply findings to bird flu and say it won't get through because avian flu is the same size virus. So, preliminary evidence is supportive at least for infected people wearing masks." He suggests doctors' offices post signs asking patients who think they have flu to advise staff and receive a mask to wear in the waiting room. He also suggests people at home with the flu wear masks when going out. Austin patients hospitalized with flu will now wear surgical instead of N95 masks when leaving their single room for tests, Grayson says. Findings strengthen the rationale for recommendations that patients in hospital with flu and healthcare workers treating them wear masks. UK guidelines recommend masks for bird flu for practical reasons, he says.

CNNHealth.com: Study: "Face Masks seem to protect against flu" 8/03/09
From Mexico to China, people around the world have worn face masks to protect against swine flu, also known as the H1N1 virus. The problem? Experts could never say for sure whether such masks actually help you stay healthy. Now, the largest study to date on the subject suggests they do. When sick people and their families wear surgical face masks and wash their hands within the first 36 hours of symptoms, healthy family members are indeed less likely to get seasonal flu, researchers say. They think the results may apply to H1N1 as well. So far, 94,512 people around the world have been infected with swine flu, and there have been 429 deaths in 122 countries. "Many people believe that coughs and colds are so infectious that there is really no stopping them, however hard we try," says Benjamin Cowling, Ph.D., the lead author of the study published this week in Annals of Internal Medicine. "Our results suggest that is not the case, and, in fact, transmission can be effectively stopped with just some simple precautions." Cowling, an assistant professor in the School of Public Health at the University of Hong Kong, and his colleagues looked at 407 locals who came down with regular seasonal flu (not swine flu), which was confirmed by laboratory tests. Health.com: Four things you didn't know about natural medicine The patients were divided into three groups: One group (the control group) was told about the benefits of a healthy diet and lifestyle in terms of preventing illness; members of a second group were told to wash their hands with soap and water frequently, including when they coughed or sneezed, and to use an alcohol hand rub after touching contaminated surfaces; and a third group's member were told to wash their hands and use surgical face masks as often as possible at home (except when they were eating or sleeping). The researchers found that when people and their families wore face masks and washed their hands within 36 hours of the first symptoms, their family members were less likely to become infected. However, those who started using masks or washing their hands after the 36-hour time period had passed saw no benefit. In tandem with hand-washing, face masks seem to work better than hand-washing alone, but the authors could not conclusively prove which intervention was responsible for the drop in infections of family members. Cowling says these results definitely apply to the H1N1 virus too, because swine flu is transmitted much as seasonal flu....... Cowling believes a surgical face mask is an effective way to reduce flu transmission; even the World Health Organization advises health-care workers to wear face masks when treating H1N1 patients, he says. He adds that N95 respirators, which are tight-fitting masks that filter airborne particles, are also beneficial, but they can be uncomfortable to wear for long periods of time.