The efficacy of medical masks and respirators against respiratory infection in healthcare workers
Objective We aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs). Methods The data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which...
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| Published in | Influenza and other respiratory viruses Vol. 11; no. 6; pp. 511 - 517 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
John Wiley & Sons, Inc
01.11.2017
John Wiley and Sons Inc |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Objective
We aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs).
Methods
The data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory‐confirmed viral respiratory infection, influenza A or B, laboratory‐confirmed bacterial colonisation and pathogens grouped by mode of transmission.
Results
Rates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory‐confirmed bacterial colonisation (RR 0.33, 95% CI 0.21‐0.51), laboratory‐confirmed viral infections (RR 0.46, 95% CI 0.23‐0.91) and droplet‐transmitted infections (RR 0.26, 95% CI 0.16‐0.42) were significantly lower in the continuous N95 arm. Laboratory‐confirmed influenza was also lowest in the continuous N95 arm (RR 0.34, 95% CI 0.10‐1.11), but the difference was not statistically significant. Rates of laboratory‐confirmed bacterial colonisation (RR 0.54, 95% CI 0.33‐0.87) and droplet‐transmitted infections (RR 0.43, 95% CI 0.25‐0.72) were also lower in the targeted N95 arm, but not in medical mask arm.
Conclusion
The results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as “airborne precautions,” provide superior protection for droplet‐transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines. |
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| AbstractList | We aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs).
The data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory-confirmed viral respiratory infection, influenza A or B, laboratory-confirmed bacterial colonisation and pathogens grouped by mode of transmission.
Rates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory-confirmed bacterial colonisation (RR 0.33, 95% CI 0.21-0.51), laboratory-confirmed viral infections (RR 0.46, 95% CI 0.23-0.91) and droplet-transmitted infections (RR 0.26, 95% CI 0.16-0.42) were significantly lower in the continuous N95 arm. Laboratory-confirmed influenza was also lowest in the continuous N95 arm (RR 0.34, 95% CI 0.10-1.11), but the difference was not statistically significant. Rates of laboratory-confirmed bacterial colonisation (RR 0.54, 95% CI 0.33-0.87) and droplet-transmitted infections (RR 0.43, 95% CI 0.25-0.72) were also lower in the targeted N95 arm, but not in medical mask arm.
The results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as "airborne precautions," provide superior protection for droplet-transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines. ObjectiveWe aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs).MethodsThe data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory‐confirmed viral respiratory infection, influenza A or B, laboratory‐confirmed bacterial colonisation and pathogens grouped by mode of transmission.ResultsRates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory‐confirmed bacterial colonisation (RR 0.33, 95% CI 0.21‐0.51), laboratory‐confirmed viral infections (RR 0.46, 95% CI 0.23‐0.91) and droplet‐transmitted infections (RR 0.26, 95% CI 0.16‐0.42) were significantly lower in the continuous N95 arm. Laboratory‐confirmed influenza was also lowest in the continuous N95 arm (RR 0.34, 95% CI 0.10‐1.11), but the difference was not statistically significant. Rates of laboratory‐confirmed bacterial colonisation (RR 0.54, 95% CI 0.33‐0.87) and droplet‐transmitted infections (RR 0.43, 95% CI 0.25‐0.72) were also lower in the targeted N95 arm, but not in medical mask arm.ConclusionThe results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as “airborne precautions,” provide superior protection for droplet‐transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines. Objective We aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs). Methods The data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory‐confirmed viral respiratory infection, influenza A or B, laboratory‐confirmed bacterial colonisation and pathogens grouped by mode of transmission. Results Rates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory‐confirmed bacterial colonisation (RR 0.33, 95% CI 0.21‐0.51), laboratory‐confirmed viral infections (RR 0.46, 95% CI 0.23‐0.91) and droplet‐transmitted infections (RR 0.26, 95% CI 0.16‐0.42) were significantly lower in the continuous N95 arm. Laboratory‐confirmed influenza was also lowest in the continuous N95 arm (RR 0.34, 95% CI 0.10‐1.11), but the difference was not statistically significant. Rates of laboratory‐confirmed bacterial colonisation (RR 0.54, 95% CI 0.33‐0.87) and droplet‐transmitted infections (RR 0.43, 95% CI 0.25‐0.72) were also lower in the targeted N95 arm, but not in medical mask arm. Conclusion The results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as “airborne precautions,” provide superior protection for droplet‐transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines. Objective: We aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs). Methods: The data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory-confirmed viral respiratory infection, influenza A or B, laboratory-confirmed bacterial colonisation and pathogens grouped by mode of transmission. Results: Rates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory-confirmed bacterial colonisation (RR 0.33, 95% CI 0.21-0.51), laboratory-confirmed viral infections (RR 0.46, 95% CI 0.23-0.91) and droplet-transmitted infections (RR 0.26, 95% CI 0.16-0.42) were significantly lower in the continuous N95 arm. Laboratory-confirmed influenza was also lowest in the continuous N95 arm (RR 0.34, 95% CI 0.10-1.11), but the difference was not statistically significant. Rates of laboratory-confirmed bacterial colonisation (RR 0.54, 95% CI 0.33-0.87) and droplet-transmitted infections (RR 0.43, 95% CI 0.25-0.72) were also lower in the targeted N95 arm, but not in medical mask arm. Conclusion: The results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as "airborne precautions," provide superior protection for droplet-transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines. We aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs). The data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory-confirmed viral respiratory infection, influenza A or B, laboratory-confirmed bacterial colonisation and pathogens grouped by mode of transmission. Rates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory-confirmed bacterial colonisation (RR 0.33, 95% CI 0.21-0.51), laboratory-confirmed viral infections (RR 0.46, 95% CI 0.23-0.91) and droplet-transmitted infections (RR 0.26, 95% CI 0.16-0.42) were significantly lower in the continuous N95 arm. Laboratory-confirmed influenza was also lowest in the continuous N95 arm (RR 0.34, 95% CI 0.10-1.11), but the difference was not statistically significant. Rates of laboratory-confirmed bacterial colonisation (RR 0.54, 95% CI 0.33-0.87) and droplet-transmitted infections (RR 0.43, 95% CI 0.25-0.72) were also lower in the targeted N95 arm, but not in medical mask arm. The results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as "airborne precautions," provide superior protection for droplet-transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines. We aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs).OBJECTIVEWe aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs).The data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory-confirmed viral respiratory infection, influenza A or B, laboratory-confirmed bacterial colonisation and pathogens grouped by mode of transmission.METHODSThe data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory-confirmed viral respiratory infection, influenza A or B, laboratory-confirmed bacterial colonisation and pathogens grouped by mode of transmission.Rates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory-confirmed bacterial colonisation (RR 0.33, 95% CI 0.21-0.51), laboratory-confirmed viral infections (RR 0.46, 95% CI 0.23-0.91) and droplet-transmitted infections (RR 0.26, 95% CI 0.16-0.42) were significantly lower in the continuous N95 arm. Laboratory-confirmed influenza was also lowest in the continuous N95 arm (RR 0.34, 95% CI 0.10-1.11), but the difference was not statistically significant. Rates of laboratory-confirmed bacterial colonisation (RR 0.54, 95% CI 0.33-0.87) and droplet-transmitted infections (RR 0.43, 95% CI 0.25-0.72) were also lower in the targeted N95 arm, but not in medical mask arm.RESULTSRates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory-confirmed bacterial colonisation (RR 0.33, 95% CI 0.21-0.51), laboratory-confirmed viral infections (RR 0.46, 95% CI 0.23-0.91) and droplet-transmitted infections (RR 0.26, 95% CI 0.16-0.42) were significantly lower in the continuous N95 arm. Laboratory-confirmed influenza was also lowest in the continuous N95 arm (RR 0.34, 95% CI 0.10-1.11), but the difference was not statistically significant. Rates of laboratory-confirmed bacterial colonisation (RR 0.54, 95% CI 0.33-0.87) and droplet-transmitted infections (RR 0.43, 95% CI 0.25-0.72) were also lower in the targeted N95 arm, but not in medical mask arm.The results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as "airborne precautions," provide superior protection for droplet-transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines.CONCLUSIONThe results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as "airborne precautions," provide superior protection for droplet-transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines. |
| Audience | Academic |
| Author | Seale, Holly Rahman, Bayzidur MacIntyre, Chandini Raina Wang, Quanyi Zhang, Yi Wang, Xiaoli Chughtai, Abrar Ahmad Peng, Yang |
| AuthorAffiliation | 1 School of Public Health and Community Medicine University of New South Wales Sydney NSW Australia 2 College of Public Service & Community Solutions and College of Health Solutions Arizona State University Phoenix AZ USA 3 The Beijing Centre for Disease Prevention and Control Beijing China |
| AuthorAffiliation_xml | – name: 2 College of Public Service & Community Solutions and College of Health Solutions Arizona State University Phoenix AZ USA – name: 3 The Beijing Centre for Disease Prevention and Control Beijing China – name: 1 School of Public Health and Community Medicine University of New South Wales Sydney NSW Australia |
| Author_xml | – sequence: 1 givenname: Chandini Raina surname: MacIntyre fullname: MacIntyre, Chandini Raina organization: Arizona State University – sequence: 2 givenname: Abrar Ahmad orcidid: 0000-0003-4203-7891 surname: Chughtai fullname: Chughtai, Abrar Ahmad email: abrar.chughtai@unsw.edu.au organization: University of New South Wales – sequence: 3 givenname: Bayzidur surname: Rahman fullname: Rahman, Bayzidur organization: University of New South Wales – sequence: 4 givenname: Yang surname: Peng fullname: Peng, Yang organization: The Beijing Centre for Disease Prevention and Control – sequence: 5 givenname: Yi surname: Zhang fullname: Zhang, Yi organization: The Beijing Centre for Disease Prevention and Control – sequence: 6 givenname: Holly surname: Seale fullname: Seale, Holly organization: University of New South Wales – sequence: 7 givenname: Xiaoli surname: Wang fullname: Wang, Xiaoli organization: The Beijing Centre for Disease Prevention and Control – sequence: 8 givenname: Quanyi surname: Wang fullname: Wang, Quanyi organization: The Beijing Centre for Disease Prevention and Control |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28799710$$D View this record in MEDLINE/PubMed |
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| Copyright | 2017 The Authors. Published by John Wiley & Sons Ltd. 2017 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd. COPYRIGHT 2017 John Wiley & Sons, Inc. 2017. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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| Issue | 6 |
| Keywords | influenza medical masks respirators droplet infections masks healthcare workers |
| Language | English |
| License | Attribution http://creativecommons.org/licenses/by/4.0 2017 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
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| Notes | Funding information Trial 2: Australian National Health & Medical Research Council of Australia (Grant # 630787). Funders were not involved in the design and implementation of the study Trial 1: 3M helped in fit testing, no financial support was provided. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3 |
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| References_xml | – volume: 207 start-page: 1037 year: 2013 end-page: 1046 article-title: Exposure to influenza virus aerosols during routine patient care publication-title: J Infect Dis – volume: 37 start-page: 417 year: 2009 end-page: 419 article-title: Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: a randomized controlled trial publication-title: Am J Infect Control – volume: 302 start-page: 1865 year: 2009 end-page: 1871 article-title: Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial publication-title: JAMA – volume: 35 start-page: S65 issue: 10 Suppl 2 year: 2007 end-page: S164 article-title: 2007 Guideline for Isolation Precautions: preventing Transmission of Infectious Agents in Health Care Settings publication-title: Am J Infect Control – volume: 6 start-page: e00137 year: 2015 end-page: 15 article-title: Transmission of ebola viruses: what we know and what we do not know publication-title: MBio – volume: 5 start-page: 170 year: 2011 end-page: 179 article-title: A cluster randomized clinical trial comparing fit‐tested and non‐fit‐tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers publication-title: Influenza Other Respir Viruses – volume: 51 start-page: 1421 year: 2014 end-page: 1426 article-title: Respiratory protection for healthcare workers treating Ebola virus disease (EVD): are facemasks sufficient to meet occupational health and safety obligations? publication-title: Int J Nurs Stud – volume: 22 start-page: 1 year: 2015 end-page: 10 article-title: A cluster randomised trial of cloth masks compared with medical masks in healthcare workers publication-title: BMJ Open – volume: 52 start-page: 899 year: 2014 end-page: 903 article-title: Uncertainty, risk analysis and change for Ebola personal protective equipment guidelines publication-title: Int J Nurs Stud – volume: 187 start-page: 960 year: 2013 end-page: 966 article-title: A randomized clinical trial of three options for N95 respirators and medical masks in health workers publication-title: Am J Respir Crit Care Med – volume: 3 start-page: 80 year: 2012 end-page: 97 article-title: Indirect and mixed‐treatment comparison, network, or multiple‐treatments meta‐analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool publication-title: Res Synth Methods – volume: 5 start-page: e15100 year: 2010 article-title: Measurements of airborne influenza virus in aerosol particles from human coughs publication-title: PLoS ONE – volume: 6 start-page: 216 year: 2013 article-title: Availability, consistency and evidence‐base of policies and guidelines on the use of mask and respirator to protect hospital health care workers: a global analysis publication-title: BMC Res Notes – volume: 350 start-page: h694 year: 2015 article-title: Facemasks for the prevention of infection in healthcare and community settings publication-title: BMJ – volume: 36 start-page: 324 year: 1946 end-page: 331 article-title: Bacteriologic procedures in the evaluation of methods for control of air‐borne infection publication-title: Am J Public Health Nation's Health – year: 2014 – year: 1998 – ident: e_1_2_11_13_1 – ident: e_1_2_11_7_1 doi: 10.1016/j.ijnurstu.2014.09.002 – ident: e_1_2_11_5_1 doi: 10.1164/rccm.201207-1164OC – ident: e_1_2_11_16_1 – ident: e_1_2_11_24_1 – ident: e_1_2_11_21_1 – ident: e_1_2_11_10_1 – ident: e_1_2_11_17_1 doi: 10.1093/infdis/jis773 – ident: e_1_2_11_3_1 doi: 10.1001/jama.2009.1466 – volume: 22 start-page: 1 year: 2015 ident: e_1_2_11_6_1 article-title: A cluster randomised trial of cloth masks compared with medical masks in healthcare workers publication-title: BMJ Open – ident: e_1_2_11_26_1 doi: 10.1136/bmj.h694 – ident: e_1_2_11_4_1 doi: 10.1111/j.1750-2659.2011.00198.x – ident: e_1_2_11_12_1 – ident: e_1_2_11_9_1 doi: 10.1128/mBio.00137-15 – ident: e_1_2_11_27_1 doi: 10.1186/1756-0500-6-216 – ident: e_1_2_11_8_1 doi: 10.2105/AJPH.36.4.324 – ident: e_1_2_11_23_1 – ident: e_1_2_11_14_1 doi: 10.1002/jrsm.1037 – ident: e_1_2_11_20_1 – ident: e_1_2_11_15_1 – ident: e_1_2_11_11_1 – ident: e_1_2_11_19_1 doi: 10.1016/j.ajic.2007.10.007 – ident: e_1_2_11_25_1 – ident: e_1_2_11_22_1 doi: 10.1016/j.ijnurstu.2014.12.001 – ident: e_1_2_11_18_1 doi: 10.1371/journal.pone.0015100 – ident: e_1_2_11_2_1 doi: 10.1016/j.ajic.2008.11.002 |
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| SubjectTerms | Accident prevention Bacteria Bacterial Infections - diagnosis Bacterial Infections - epidemiology Bacterial Infections - prevention & control Bacterial Infections - transmission China - epidemiology Clinical Laboratory Techniques Clinical trials Colonization Comparative analysis Control methods Disease transmission droplet infections Guidelines Health aspects Health care Health Personnel - statistics & numerical data healthcare workers Humans Infection Control - instrumentation Infection Control - methods Infection Control - statistics & numerical data Infections Influenza Influenza A Influenza, Human - diagnosis Influenza, Human - epidemiology Influenza, Human - prevention & control Influenza, Human - transmission Laboratories Lung diseases Masks Masks - statistics & numerical data medical masks Medical personnel Medical research Occupational Exposure - prevention & control Occupational health Original Prevention Protective equipment Respirators Respiratory diseases Respiratory tract infection Respiratory Tract Infections - diagnosis Respiratory Tract Infections - prevention & control Respiratory Tract Infections - virology Statistical analysis Ventilators Ventilators, Mechanical - classification Ventilators, Mechanical - statistics & numerical data Viral infections Virus Diseases - epidemiology Virus Diseases - prevention & control Virus Diseases - transmission Viruses |
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| Title | The efficacy of medical masks and respirators against respiratory infection in healthcare workers |
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