N95 respirators -- not surgical masks -- recommended for H1N1 protection

With the school year starting, the number of people, especially children, infected with influenza A(H1N1) is beginning to rise, and physicians are being warned to protect themselves from virus.

A Sept. 3 Institute of Medicine report advised physicians and other health care professionals to use well-fitted N95 respirators rather than looser-fitting medical masks to guard against contracting the H1N1 virus while treating patients.

Doctors should not stop there, the report said. Vaccination, antiviral use, hand-washing, disinfection and gloves also should be incorporated into care of patients with respiratory symptoms.

But the panel's recommendation of the N95 respirator, which office-based physicians typically don't stock, has raised some concerns.

The Centers for Disease Control and Prevention will provide additional advice about the masks. During an H1N1 news briefing an hour after the IOM report was released, CDC Director Thomas Frieden, MD, said his agency would be "looking carefully at [the report] in the coming days to weeks."

Dr. Frieden said the IOM committee that wrote the report was instructed not to consider economic or logistical concerns, such as supply, when evaluating personal protective equipment designed to guard against respiratory infection.

As a result, the report may not be as useful as it could have been, according to one expert.

"Those were two huge limitations," said William Schaffner, MD, chair of the Dept. of Preventive Medicine at Vanderbilt University in Tennessee. The CDC will have to translate the report "into the real world of applications."

Masks can be difficult to wear

The N95 devices are not widely used by office-based physicians, and they are difficult to wear for long periods because they restrict breathing, Dr. Schaffner said. "Nurses who care for patients with active tuberculosis can only manage to wear them for 15 to 30 minutes at a time."

The IOM panel cautioned against relying solely on the N95 mask to control infection. "There is a lot we still don't know about these viruses, and it would be a mistake for anyone to rely on respirators alone as some sort of a magic shield," said panel Chair Kenneth Shine, MD, executive vice chancellor for health affairs at the University of Texas System in Austin.

During the CDC news briefing, Dr. Frieden also addressed a CDC surveillance report showing that 36 children died from the H1N1 virus between April and August this year. Most of the children had an underlying chronic condition such as cerebral palsy.

Dr. Frieden said the agency is working with pediatric societies and parent groups to make sure children with special needs are treated promptly if they develop a fever during flu season. These children also should be at the front of the line for the H1N1 vaccine when it becomes available, probably in mid-October, he said.