Recommendations and Reports FIGURE 5. Phased addition of nonpharmaceutical interventions to prevent the spread of pandemic influenza in communities Seasonal or novel Severity and influenza virus transmissibility Recommended NPIs Expected outcomes All levels of seasonal NPIs that are recommended at all times Seasonal influenza severity Personal and transmissibility • Voluntary home isolation (staying home when ill) • Respiratory etiquette (covering coughs and sneezes) • Hand hygiene (washing hands with soap and water or use of alcohol- based hand sanitizer when soap and water are not available) Environmental • Routine surface cleaning of frequently touched surfaces and objects • Reduced spread of (e.g., tables, door knobs, toys, desks, and computer keyboards) infectious disease • Reduced load for health care facilities • Low to medium NPIs that might be added during a pandemic • Reduced morbidity severity and Personal and mortality transmissibility • Voluntary home quarantine (household members of ill persons stay Novel • High transmissibility home for up to 3 days and then remain home if they become ill) (potential and low to medium • Face mask use by ill persons for source control pandemic) severity Community • High to very high • School closures and dismissals transmissibility and • Mass gathering modifications/postponements/cancellations severity • Other social distancing measures (e.g., offering telecommuting in workplaces or seating students further apart in classrooms) Abbreviation: NPI = nonpharmaceutical intervention. might be beneficial in certain situations (e.g., when persons CDC recommendations at high risk for influenza complications cannot avoid crowded Use of face masks by ill persons: CDC might recommend the use of settings or parents are caring for ill children at home). Face face masks by ill persons as a source control measure during severe, mask use by well persons also might reduce self-inoculation very severe, or extreme influenza pandemics when crowded community settings cannot be avoided (e.g., when adults and children with influenza (e.g., touching the nose with the hand after touching a symptoms seek medical attention) or when ill persons are in close contact contaminated surface). with others (e.g., when symptomatic persons share common spaces with Settings and use. Disposable surgical, medical, and dental other household members or symptomatic postpartum women care for and nurse their infants). Some evidence indicates that face mask use by procedure masks are used widely in health care settings ill persons might protect others from infection. to prevent exposure to respiratory infections. Face masks 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 have few secondary consequences (e.g., discomfort or settings as a means of avoiding infection during influenza pandemics difficulty breathing) when worn properly and consistently, except under special, high-risk circumstances (https://www.cdc.gov/flu/ professionals/infectioncontrol/maskguidance.htm). For example, during and face masks sized for children are available. (Additional a severe pandemic, pregnant women and other persons at high risk for information about face masks is available at https://www. influenza complications might use face masks if unable to avoid crowded settings, especially if no pandemic vaccine is available. In addition, persons fda.gov/medicaldevices/productsandmedicalprocedures/ caring for ill family members at home (e.g., a parent of a child exhibiting generalhospitaldevicesandsupplies/personalprotectiveequipment/ influenza symptoms) might use face masks to avoid infection when in ucm055977.htm and https://www.osha.gov/Publications/ close contact with a patient, just as health care personnel wear masks in health care settings. respirators-vs-surgicalmasks-factsheet.html.) US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / April 21, 2017 / Vol. 66 / No. 1 15