THURSDAY, Nov. 5, 2009 (Health.com) — A preliminary report suggesting that N95 respirators—filtering devices worn over the mouth and nose—protect against swine flu better than surgical face masks seems to be incorrect, researchers revealed during a meeting of the Infectious Diseases Society of America (IDSA).

In fact, surgical face masks, which are cheaper and easier to wear, may be just as good as N95 respirators. At the very least, researchers can’t prove that one is better than the other. It’s the latest wrinkle in a continuing debate over how to protect health-care workers from the H1N1 virus, also known as swine flu.

Raina MacIntyre, PhD, a professor of infectious diseases epidemiology and the head of the University of New South Wales School of Public Health and Community Medicine, in Sydney, Australia, says the research team didn’t exactly retract the findings.

“We simply did the analysis of the same data differently for the final paper,” she explains.

For the new analysis, the researchers removed a control group of nearly 500 health-care workers and made other statistical adjustments. Ultimately, the difference in infection rates between mask and respirator users was not statistically significant.

“[The study] still shows a likely superiority of N95s, with half the rate of infection compared to surgical [masks],” MacIntyre says. “But the study was probably underpowered to pick up statistical significance when we removed the control group.”

“I would certainly wear an N95 respirator if I were exposed to infectious patients,” she adds.

The N95 respirator is a tightly fitted facial mask designed to filter out even very fine airborne particles, according to the U.S. Food and Drug Administration (FDA). Looser-fitting surgical masks protect against large-particle droplets, splashes, sprays, or splatter, the FDA says, but they don’t completely block the germs from coughs and sneezes.

To figure out which protective device is best, MacIntyre and her colleagues tracked hospital workers in Beijing, China, who wore surgical masks or N95 respirators, and compared rates of influenza and respiratory illness. Preliminary findings were presented at a meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy in September 2009. Final results have yet to be published.

The only other randomized clinical trial comparing health-care workers’ use of respirators and surgical masks was published online in October 2009 in the Journal of the American Medical Association. Canadian researchers reported no difference in influenza rates among nurses using one type of protective device versus the other.

Both studies helped inform an Institute of Medicine (IOM) panel that, in September 2009, issued a report recommending the use of fitted N95 respirators by health-care workers who interact with patients with confirmed or suspected cases of H1N1. (MacIntyre was also a member of that panel.) However, because the two studies were preliminary, the committee said that it could not draw conclusions from either.

“The take-home message for me is that, in clinical settings, wearing a mask or an N95 appears to be essentially equivalent,” says Mark E. Rupp, MD, a professor of infectious diseases at the University of Nebraska Medical Center in Omaha and president of the Society for Healthcare Epidemiology of America (SHEA).

Data presented at the IDSA meeting also highlighted the problems with N95 respirators, Dr. Rupp says. Health-care workers say that the respirators are uncomfortable and more difficult to wear than face masks, and that they make it hard to speak with patients, among other problems, he explains. They’re more expensive too.

Although respirator use made sense at the beginning of the swine flu pandemic, it now appears that H1N1 behaves similarly to seasonal influenza, Dr. Rupp says, so “it doesn’t make much sense to be using different precautions for seasonal flu than we use for H1N1.”

The SHEA would like to see federal guidelines revised, he says.

Still, government health and safety organizations are standing by the more stringent standard of protection.

IOM spokeswoman Christine Stencel says that the National Institute for Occupational Safety and Health and others have provided “convincing data” on the ability of the respirators to filter out a large percentage of tiny particles.

“Based on all the available evidence and data that the committee had to look at, [it recommended] that the N95 respirator afforded the best potential protection against airborne transmission of the virus, and therefore that was the recommendation for health-care workers in terms of respiratory protection,” she says.

The Centers for Disease Control and Prevention (CDC) developed its policy independently of the IOM and the MacIntyre study, explains CDC spokesman Jeff Dimond. However, it’s similar in terms of respirator use. The CDC recommends that health-care workers in close contact with people with suspected or confirmed H1N1 influenza use a properly fitted, disposable N95 respirator, or something that offers similar or better protection.

The current recommendation is based on unique conditions associated with the current pandemic, including low levels of population immunity to 2009 H1N1, the potential for health-care personnel to be exposed to H1N1 patients, and other factors, Dimond says.

In October 2009, the Occupational Safety and Health Administration (OSHA) said it would soon issue a “compliance directive” to ensure that health-care facilities have controls in place to protect workers from occupational exposures to swine flu. OSHA said its directive would closely follow the CDC’s guidance.

In Dr. Rupp’s opinion, the respiratory protection debate has distracted from other crucial flu-fighting measures. These include:

• Quickly identifying and isolating patients with influenza-like illness.
• Preaching respiratory etiquette programs. Patients who are ill should be asked to wear a surgical mask to contain their secretions, he says, and they should use tissues and wash their hands frequently to prevent touch contamination.
• Encouraging hospital visitors to stay home if they’re sick and urging health-care workers to stay home when they’re sick.
• Getting seasonal and H1N1 vaccines. “For health-care workers, that is by far the best way to protect them,” he says.

No matter where you go in life, somebody’s sneezing, and possibly spreading colds, the flu, or other infections. Strangers on the elevator, kids at day care, even those self-important colleagues who refuse to take sick days—they all pose a risk. Avoiding germy people is your best defense, but boosting your immunity is just as important for preventing colds, flus, and infections. And because your immune system naturally weakens as you age, charging it up is crucial during cold-and-flu season. Here, an age-specific plan for optimum protection.

Your 30s

Limit sugar and alcohol
Life in your 30s often means fast-tracking a career, starting a family, and keeping up with an active social life—all at the same time. That can mean meals on the fly, sugary snacks for energy, and some social drinking on the weekends. As a result, your immunity can suffer, says Mark Moyad, MD, director of preventive and alternative medicine at the University of Michigan Medical Center. “The sugar in just one can of soda can compromise immune system function by 30% for up to three hours,” he explains. How? By immobilizing some immunity cells and hurting their ability to surround and ultimately destroy bacteria. In addition, anything more than a few alcoholic drinks per week reduces the number of immunity-providing cells your body produces.

Dr. Moyad recommends that you not only limit drinking but also replace sweets with high-fiber snacks like oatmeal, whole-wheat muffins, or apples. Fiber is actually a prebiotic—a food source for probiotics, the friendly bacteria in yogurt and other products that help keep your gut strong enough to fend off invading bacteria and viruses. Also, try starting your day with cereals containing buckwheat (try Arrowhead Mills Organic Maple Buckwheat Flakes) or wheat germ (Kretschmer Wheat Germ); both are high in polyphenols, natural compounds linked to longer life and increased immunity.

Work out smarter, not harder
Robo-routines that get you a hard body in a few weeks may boost your physical confidence, but they actually slow down your immune system, says Len Horovitz, MD, a pulmonary specialist and flu expert at Lenox Hill Hospital in New York City. Studies show that moderate exercise, however, helps immune cells circulate through the bloodstream at a more rapid pace, making it less likely that bacteria or viruses will slip through unnoticed. And the effect is cumulative over time. Aim for about 20 minutes of aerobic exercise (walking or running, for instance) plus 15 to 20 minutes of strength training three times a week. Then try some yoga for an extra boost: A Washington State University study suggests that doing yoga three times weekly—the equivalent of a moderate-intensity exercise program—reduces a key marker for stress inside the body, helping to increase immunity.

Your 40s

Go to bed earlier
You may relish your downtime before bed—who doesn’t want an hour to read or watch TV after the evening rigors of helping with homework, doing the dishes or laundry, and whipping the household budget into shape? But if you relax at the expense of getting real sleep, fighting off colds gets harder. As little as 30 to 60 minutes of additional sack time per night is enough to up your immunity, Dr. Moyad says. “Sleep is a restorative process, and it’s necessary for the immune system to function properly,” he explains. Even a nap can help. “When you feel tired don’t fight it,” Dr. Moyad adds. “It’s your body’s way of telling you that you need to recharge.”

Learn new ways to relax
Chronic stress—whether it’s from a frustrating daily commute or problems on the job—slows down your immune system, making it react less efficiently to a threat like the flu virus, for instance. To fight back, try new forms of heavy-duty relaxation, says Jacob Teitelbaum, MD, medical director of the nationwide Fibromyalgia and Fatigue Centers; he recommends transcendental meditation.

Your 50s and beyond

Amp up antioxidants
In your 50s, your risk of disease rises fast. To pump up your immunity, add more antioxidant-rich fruits and veggies to your diet. Research from the University of California, Berkeley, suggests that broccoli, cabbage, and kale offer the biggest immune system boost because they contain an important cancer-fighting compound. You hated kale the last time you tried it 10 years ago? Some evidence suggests that taste buds can “mature” in a way that can turn foods you’ve never liked into pleasurable adventures.

Another smart choice, according to pharmacist Suzy Cohen, RPh, author of Drug Muggers: How to Keep Your Medicine From Stealing the Life Out of You, is a cup of tea—but not just any cup. Her favorite is matcha, a powdered form of ground-up green tea leaves sold under many brand names and found in most health-food stores as well as online. One cup of matcha will net you the antioxidant protection found in 10 cups of brewed green tea and up to 100 times the antioxidant power of vitamins C and E, she says. Dr. Moyad suggests adding a spoonful of honey to your tea for extra protection: “It has incredible antibacterial powers.”

Follow your dreams
Pay a little more attention to those long-lost goals that help define the meaning of life—and your immune system’s natural killer cells may multiply, according to a University of California, Los Angeles, study. While researchers aren’t sure why, one theory suggests that focusing on what you really want to do reduces the immunity-robbing impact of everyday stress. Dr. Moyad says volunteering in your community can pump up your germ-fighting powers even more. Studies show that those who volunteer not only are healthier but actually live longer than folks who don’t. Stress reduction may be the hidden link.

Get your groove back
Now that the kids may be out of the house for long periods, make more time for sex. A study from Wilkes University in Wilkes-Barre, Pa., found that men and women who had one to two sexual encounters per week had a 30% increase in IgA, antibodies found in saliva and mucous membranes that are considered the first line of defense against cold and flu viruses. Exactly how or why sex causes the increase is not well understood—but sometimes science is just there to enjoy!

This article was first published in Health magazine, December 2008.