Recommendations and Reports Personal Protective Measures Reserved for of the 1918 pandemic, and mathematical modeling studies Pandemics (supplementary Chapter 3 https://stacks.cdc.gov/view/cdc/44313 Voluntary home isolation, respiratory etiquette, and hand and supplementary Appendix 5 https://stacks.cdc.gov/view/ hygiene are recommended during both annual influenza cdc/44314). seasons and influenza pandemics. Additional personal protective Settings and use. Voluntary home quarantine of exposed measures that might be recommended during pandemics include household members might be recommended during severe, voluntary home quarantine of exposed household members and very severe, or extreme influenza pandemics (Table 10) the use of face masks in community settings when ill. These to help reduce the chance of transmitting the virus to measures might contribute to reductions in transmission of others outside of the household. Advance planning is pandemic influenza viruses when the level of pandemic severity needed to minimize potential secondary consequences and local conditions warrant their use (supplementary Chapter 3 for persons who have special cultural, economic, legal, https://stacks.cdc.gov/view/cdc/44313). mental, physical, or social status needs (e.g., older adults who depend on necessary community-based services such Voluntary Home Quarantine as home-delivered meals and transportation to health Voluntary home quarantine of non-ill household members of care services). Other secondary consequences might persons with influenza (also called self-quarantine or household include missed work and loss of income for persons whose quarantine) helps prevent disease spread from households employers do not have paid sick leave policies that include to schools, workplaces, and other households because those home quarantine during pandemics. household members have been exposed to the influenza virus. CDC recommendations Exposed household members of symptomatic persons (with Voluntary home quarantine: CDC might recommend voluntary home confirmed or probable pandemic influenza) should stay home quarantine of exposed household members as a personal protective for up to 3 days (the estimated incubation period for seasonal measure during severe, very severe, or extreme influenza pandemics in influenza) (61) starting from their initial contact with the ill combination with other personal protective measures such as respiratory etiquette and hand hygiene. If a member of the household is symptomatic person. If they then become ill, they should practice voluntary with confirmed or probable pandemic influenza, then all members of the home isolation (i.e., they should remain at home until recovered household should stay home for up to 3 days (the estimated incubation period for seasonal influenza),¶¶ starting from their initial contact with the as discussed previously; https://www.cdc.gov/quarantine/ ill person, to monitor for influenza symptoms. index.html). For certain exposed household members (e.g., those at high risk for influenza complications or with severe Use of Face Masks in Community Settings immune deficiencies), guidelines should be consulted regarding the prophylactic use of antiviral medications (https://www.cdc. Face masks (disposable surgical, medical, or dental procedure gov/flu/professionals/antivirals/index.htm). masks) are widely used by health care workers to prevent Rationale for use as a public health strategy. Voluntary respiratory infections both in health care workers and patients. home quarantine might help slow a pandemic by reducing They also might be worn by ill persons during severe, very community transmission from households with a person who severe, or extreme pandemics to prevent spread of influenza to has influenza because the exposed household members are at household members and others in the community. However, increased risk for infection. Furthermore, certain infected (but little evidence supports the use of face masks by well persons not yet symptomatic) household members could begin shedding in community settings, although some trials conducted during influenza virus at least a day before exhibiting symptoms and the 2009 H1N1 pandemic found that early combined use of could infect friends, neighbors, and others in the community face masks and other NPIs (such as hand hygiene) might be (e.g., at school or work) before becoming symptomatic. Therefore, effective (supplementary Chapter 3 https://stacks.cdc.gov/ all members of a household with a symptomatic person (with view/cdc/44313). confirmed or probable pandemic influenza) might be asked to Rationale for use as a public health strategy. Face masks stay home for a specified period of time (up to 3 days) to assess for provide a physical barrier that prevents the transmission early signs and symptoms of pandemic influenza virus infection. If of influenza viruses from an ill person to a well person by other household members become ill during this period, then the blocking large-particle respiratory droplets propelled by time for voluntary home quarantine might need to be extended coughing or sneezing. Face mask use by well persons is not for another incubation period. The evidence for voluntary home routinely needed in most situations to prevent acquiring the quarantine, particularly when used in combination with other influenza virus. However, use of face masks by well persons NPIs, includes a systematic literature review, historical analyses ¶¶ If the incubation period for the next pandemic were shorter or longer than 3 days, CDC would amend the recommendation accordingly. 14 MMWR / April 21, 2017 / Vol. 66 / No. 1 US Department of Health and Human Services/Centers for Disease Control and Prevention