4/21/2017, “Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017,” cdc.gov
“The guidelines were developed during October 2011–October 2016….
These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States — Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425)….
CDC recommendations
Use of face masks by ill persons:
CDC might recommend the use of face masks by ill persons as a source control measure during severe, very severe, or extreme influenza pandemics when crowded community settings cannot be avoided (e.g., when adults and children with influenza symptoms seek medical attention) or when ill persons are in close contact with others (e.g., when symptomatic persons share common spaces with other household members or symptomatic postpartum women care for and nurse their infants). Some evidence indicates that face mask use by ill persons might protect others from infection.
Use of face masks by well persons
CDC does not routinely recommend the use of face masks by well persons in the home or other community settings as a means of avoiding infection during influenza pandemics except under special, high-risk circumstances (https://www.cdc.gov/flu/professionals/infectioncontrol/maskguidance.htm). For example, during a severe pandemic, pregnant women and other persons at high risk for influenza complications might use face masks if unable to avoid crowded settings, especially if no pandemic vaccine is available. In addition, persons caring for ill family members at home (e.g., a parent of a child exhibiting influenza symptoms) might use face masks to avoid infection when in close contact with a patient, just as health care personnel wear masks in health care settings….
Use of Face Masks in Community Settings
They also might be worn by ill persons during severe, very severe, or extreme pandemics to prevent spread of influenza to household members and others in the community. However, little evidence supports the use of face masks by well persons in community settings, although some trials conducted during the 2009 H1N1 pandemic found that early combined use of face masks and other NPIs (such as hand hygiene) might be effective (supplementary Chapter 3 https://stacks.cdc.gov/view/cdc/44313)
Rationale for use as a public health strategy.
Face masks provide a physical barrier that prevents the transmission of influenza viruses from an ill person to a well person by blocking large-particle respiratory droplets propelled by coughing or sneezing. Face mask use by well persons is not routinely needed in most situations to prevent acquiring the influenza virus. However, use of face masks by well persons might be beneficial in certain situations (e.g., when persons at high risk for influenza complications cannot avoid crowded settings or parents are caring for ill children at home). Face mask use by well persons also might reduce self-inoculation (e.g., touching the nose with the hand after touching a contaminated surface).
Settings and use. Disposable surgical, medical, and dental procedure masks are used widely in health care settings to prevent exposure to respiratory infections. Face masks have few secondary consequences (e.g., discomfort or difficulty breathing) when worn properly and consistently, and face masks sized for children are available. (Additional information about face masks is available at https://www.fda.gov/medicaldevices/productsandmedicalprocedures/generalhospitaldevicesandsupplies/personalprotectiveequipment/ucm055977.htmexternal icon and https://www.osha.gov/Publications/respirators-vs-surgicalmasks-factsheet.htmlexternal icon.)
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Added: More from the April 21, 2017 CDC guidelines:
“Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017,” cdc.gov
Recommendations and Reports / April 21, 2017 / 66(1);1–34
Noreen Qualls, DrPH1; Alexandra Levitt, PhD2; Neha Kanade, MPH1,3; Narue Wright-Jegede, MPH1,4; Stephanie Dopson, ScD5; Matthew Biggerstaff, MPH6; Carrie Reed, DSc6; Amra Uzicanin, MD1 (View author affiliations)View suggested citation “Summary
When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.
These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States — Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time.
Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).
Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1) pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).
Introduction
These 2017 guidelines provide evidence-based recommendations on the use of NPIs in mitigating the effects of pandemic influenza. These guidelines update and expand the 2007 strategy (https://stacks.cdc.gov/view/cdc/11425).*
Purpose
Specific goals for implementing NPIs early in a pandemic include slowing acceleration of the number of cases in a community, reducing the peak number of cases during the pandemic and related health care demands on hospitals and infrastructure, and decreasing overall cases and health effects ( Figure 1). When a pandemic begins, public health authorities need to decide on an appropriate set of NPIs for implementation and to reiterate the importance of personal protective measures for everyday use (e.g., voluntary home isolation of ill persons [staying home when ill], respiratory etiquette, and hand hygiene) and environmental cleaning measures (e.g., routine cleaning of frequently touched surfaces), which are recommended at all times for prevention of respiratory illnesses ( Table 1). Personal protective measures reserved for pandemics (e.g., voluntary home quarantine of exposed household members [staying home when a household member is ill] and use of face masks by ill persons) also might be recommended (Table 1). A more difficult decision is how and when to implement community-level NPIs that might be warranted but are more disruptive (e.g., temporary school closures and dismissals, social distancing in workplaces and the community, and cancellation of mass gatherings) (Table 1). These decisions are made by state and local officials on the basis of conditions in the applicable jurisdictions, with guidance from CDC (according to pandemic severity and potential efficacy) and governing authorities (1). Prepandemic planning, along with community engagement, is an essential component of these decisions ( Table 2).
The decision regarding whether and when to recommend additional NPIs is another component ( Table 3). State and local public health departments might use certain influenza surveillance indicators to help decide when to consider implementing NPIs such as school closures and dismissals and other social distancing measures in schools, workplaces, and public settings during an influenza pandemic. The choice of influenza surveillance indicators might differ among states and localities, depending on the availability and capacity of their public health resources. Examples of possible influenza surveillance indicators include additional patient visits to health care providers for influenza-like illness (ILI) and increased geographic spread of influenza within a state. Indicators for school closures and dismissals might include increased school absenteeism rates or the earliest laboratory-confirmed influenza cases among students, teachers, or staff members. Indicators that might help confirm that NPI implementation should continue include increased influenza-associated hospitalizations or increases in adult or pediatric deaths attributed to influenza. Additional information about NPI prepandemic planning is available (supplementary Chapter 1 https://stacks.cdc.gov/view/cdc/44313).
Background
This 2017 update was developed through collaboration involving input from several sources, including peer-reviewed scientific literature, current research, CDC subject-matter experts, and external stakeholders (e.g., federal agencies, public health officials, and business and education partners).
Development of these updated guidelines involved participation by multiple CDC groups (e.g., the Community Mitigation Guidelines Work Group and the coordination, abstraction, and consultation teams), as well as a group of external stakeholders who reviewed a document, summarizing the overall direction and key principles and concepts of the guidelines. Input from the work group members, subject-matter experts, and stakeholders was considered and incorporated during the creation of the 2017 planning guidelines. The guidelines were developed during October 2011–October 2016 ( Table 7). The complete list of contributors and their roles in the process are available (supplementary Appendix 2 https://stacks.cdc.gov/view/cdc/44314)."
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Added:
March 31, 2014, “Threatened pandemics and laboratory escapes: Self-fulfilling prophecies," Bulletin of the Atomic Scientists, Martin Furmanski
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