Protect yourself against flu: Learn more about preventive measures
In addition to vaccination, there are a number of personal measures that people may take to reduce their risk of acquiring influenza. Influenza is a viral infection that spreads from person to person principally when people cough or sneeze, or by direct or indirect contact with respiratory secretions from infectious people that are on their hands or on surfaces. The following recommendations are based on evidence from scientific studies and public health expertise.
Personal measures for protecting yourself
1. Avoid close contact with sick people
(a) People with one or more of the following symptoms: fever, cough, sore throat, body aches, headache, chills and fatigue may be infected with influenza or another virus.
(b) Maintain a distance of at least one metre from someone with symptoms of influenza and avoid crowded situations. When distance cannot be maintained, reduce the time of close contact with people who might be ill as much as possible. When sick people or crowded situations cannot be avoided, reduce the time in these situations to the extent possible.
(c) Do not unnecessarily visit people who are sick.
(d) When caring for people who may have influenza, avoid being face-to-face with the sick person and minimise close contact.
(e) When holding sick children, place their chin on your shoulder so they will not cough in your face.
2. Wash or clean your hands frequently
(a) Hand hygiene is commonly performed by washing hands with soap and water, alcohol-based hand rub, or other waterless hand disinfectants, all of which are easily accessible, available, affordable, and well accepted in most communities. Washing or disinfecting your hands often will help protect you from the virus. Wash your hands thoroughly with soap and water, especially after you cough or sneeze. Alcohol-based hand sanitisers reduce the amount of influenza virus on contaminated hands, although washing with soap and water is more effective.
(b) When caring for someone who may have influenza, make sure to wash your hands after touching the sick person and after handling their tissues or laundry.
(c) Washing hands should not be just a quick rinse; it should go on for at least 20 seconds every time.
(d) After washing with soap and water, dry hands thoroughly with, if available, single-use paper towels or a warm air dryer.
3. Avoid touching your eyes, nose or mouth
(a) Viruses are often spread when a person touches something that is contaminated with germs and then touches their eyes, nose, or mouth.
Personal measures to protect family members and other close contacts if you are sick
1. Maintain good respiratory hygiene and cough etiquette
(a) Respiratory hygiene and cough etiquette mean preventing other people from being exposed to your own potentially infectious nasal and oral discharge. If you are sick, you should cover your nose and mouth with a tissue or a mask (but not a hand) when coughing or sneezing, followed by appropriately disposing of used tissues, and conduct proper hand hygiene after contact with respiratory secretions. Cough etiquette includes turning the head and covering the mouth when coughing and coughing or sneezing into a sleeve or elbow, rather than a hand. The rationale for not coughing into hands is to prevent subsequent contamination of other surfaces or objects. Tissues should be thrown in a lidded bin after use.
2. Wash or clean your hands frequently
(a) Hand hygiene practice is commonly performed with soap and water, alcohol-based hand rub, or other waterless hand disinfectants, all of which are easily accessible, available, affordable, and well accepted in most communities. Washing or disinfecting your hands often will help protect others from your germs. Wash your hands thoroughly with soap and water, especially after you cough or sneeze. Alcohol-based hand sanitisers reduce the amount of influenza virus on contaminated hands, although washing with soap and water is more effective.
(b) Washing hands should not be just a quick rinse; it should go on for at least 20 seconds each time.
(c) After washing with soap and water, dry hands thoroughly with, if available, single-use paper towels or warm air dryer.
3. Environmental measures
3.1 Surface and object cleaning
(a) Given that influenza virus can survive on some surfaces for prolonged periods, cleaning or disinfection procedures can effectively reduce or inactivate influenza virus from surfaces and objects.
3.2 Increased ventilation
(a) Increased ventilation is considered helpful in reducing transmission, specifically in relation to aerosol transmission and perhaps to a lesser extent large respiratory droplet transmission or indirect contact transmission. Studies have predicted a reduction of transmission of influenza when doubling or tripling the ventilation rate. Therefore, increasing ventilation is recommended in all settings to reduce the transmission of influenza virus.
4. Stay home from work or school and limit contact with others if you are sick
(a) In addition to the hygiene measures described above, people who are diagnosed with influenza by a physician or who have a febrile respiratory illness during a period of increased influenza activity in the community should remain at home at least 4-5 days after symptoms onset to avoid exposing other members of the public. Usually, adults who are sick can infect others for approximately five days after symptoms start, and children for approximately seven days after symptoms start. However, it is prudent to consider someone infectious for the entire time they have symptoms. If symptomatic people cannot stay home during the acute phase of their illness, consideration should be given to having them wear a mask in public places when they may have close contact with others. If possible, healthy people should maintain a distance of at least one metre from someone with symptoms of influenza.
Face masks
The recommendations for mask-wearing have changed substantially during the COVID-19 pandemic, as it has been one of the most important measures to contain and reduce the ongoing community transmission. A lot of evidence has emerged since the beginning of the pandemic regarding mask effectiveness at reducing the spread of SARS-CoV-2. Since influenza follows the same transmission route as SARS-CoV-2, ECDC recommends wearing a mask in confined public spaces, such as stores, supermarkets, transportation hubs and when using public transport. Wearing a face mask should be considered in crowded outdoor settings where physical distancing is not possible. Moreover, face masks should be taken into consideration in the period of co-circulation of influenza and SARS-CoV-2, especially for vulnerable categories, such as elderly people or those with underlying medical conditions.
A face mask should be used correctly to achieve the desired effect. Incorrect usage may increase, rather than decrease, the spread of respiratory infections. If a face mask is worn and disposed of properly, there is a low chance that it will cause a problem or increase the chance of infection. On the other hand, studies have shown that respirators are more effective than medical face masks, both in limiting the release of infectious respiratory droplets when worn by an infected person and in limiting the exposure when worn by the exposed person.
If used correctly, face masks can help prevent exposures and reduce the risk of infection, but they should be used along with other preventive measures, such as avoiding close contact and maintaining good hand hygiene.
Use of a face mask by sick people to protect others in the context of community outbreaks of influenza
(1) People with influenza-like symptoms should isolate and avoid close contacts with other people. If this is not possible, the use of a face mask by people who are ill with influenza symptoms may help contain respiratory secretions when the person coughs or sneezes and lower the risk for infection among close contacts. Situations where this may be useful include:
(a) when travelling home or to a hospital after developing symptoms;
(b) when being cared for at home by family members or others. For the prevention of transmission from an individual with influenza symptoms to other family members, a face mask should be worn as soon as possible (within 24 hours of the onset of the symptoms);
(c) when otherwise unavoidably having close contact with healthy people; and
(d) when symptomatic, post-partum women are caring for and nursing their infant.
Use of a face mask to protect a healthy person caring for someone who has symptoms of influenza
(1) People with influenza-like symptoms should isolate and avoid close contacts with other people. However, the use of a face mask by someone who is well is intended to prevent inadvertent contact of the person’s mouth and nose with contamination on their hands and from other peoples’ coughs and sneezes. People who are well for whom a face mask may provide additional protection include:
(a) Family members or others in the home or another non-healthcare setting providing care for someone sick with influenza symptoms and who must have close contact (within one metre).
(b) Caregivers if the person with symptoms is using a nebulizer to receive respiratory medication; a particulate respirator-type mask can be considered.
(c) Healthy people entering a hospital during increased community influenza activity or in confined public spaces.
How to properly use and dispose of face masks
1. Properly put on a face mask:
(a) Clean your hands with soap and water or hand sanitizer before touching the mask.
(b) Remove a mask from the box and make sure there are no obvious tears or holes in either side of the mask.
(c) Ensure that the coloured side of the face mask is facing outward (for coloured face masks) or that the side with folds is facing downward and outward (for uncoloured face masks).
(d) Ensure that the part with metal strip is on the upper side.
(e) Follow the instructions below for the type of mask you are using:
- Face mask with ear loops: Hold the mask by the ear loops. Place a loop around each ear.
- Face mask with ties: Bring the mask to your nose level and place the ties over the crown of your head and secure with a bow.
- Face mask with bands: Hold the mask in your hand with the nosepiece or top of the mask at fingertips, allowing the headbands to hang freely below hands. Bring the mask to your nose level and pull the top strap over your head so that it rests over the crown of your head. Pull the bottom strap over your head so that it rests at the nape of your neck.
(f) Press firmly on the metal strip so that it follows the shape of the bridge of the nose and face.
(g) Extend the face mask to cover the nose, mouth and chin.
(h) Avoid touching the face mask once secured on the face or perform hand hygiene before and after touching the face mask.
2. Replace face masks when they become damp/humid.
(a) After prolonged use, face masks may become damp/humid. At this point they should be replaced by a new or a clean, dry face mask. Do not re-use single-use masks.
3. Properly remove and dispose of a face mask:
(a) Clean your hands with soap and water or hand sanitizer before touching the mask. Avoid touching the front of the mask. The front of the mask is contaminated. Only touch the ear loops/ties/band.
(b) Follow the instructions below for the type of mask you are using:
- Face mask with ear loops: Hold both ear loops and gently lift and remove the mask.
- Face mask with ties: Untie the bottom bow first then untie the top bow and pull the mask away from you as the ties are loosened.
- Face mask with bands: Lift the bottom strap over your headfirst, then pull the top strap over your head.
(c) Do not allow the mask to touch or contaminate surfaces or clothes
(d) Dispose of the used face mask in a plastic or paper bag or a lidded bin.
(e) Clean your hands with soap and water or hand sanitizer.
Background and evidence for these recommendations
Personal protective measures for reducing the risk of acquiring or transmitting human influenza
Centre for Health Protection. Use mask properly protect ourselves and protect others. 2019.
Other references
Brankston G, Gitterman L, Hirji Z, Lemieux C, Gardam M. Transmission of influenza A in human beings. Lancet Infect Dis. 2007 Apr;7(4):257-65. Jefferson T, Del Mar C, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ. 2009 Sep 21;339:b3675.Influenza Transmission and the Role of Personal Protective Respiratory Equipment: An Assessment of The Evidence – The Expert Panel on Influenza and Personal Protective Respiratory Equipment. Council of Canadian Academies. 2007. Ontario, Canada.
Cowling BJ, Fung RO, Cheng CK, Fang VJ, Chan KH, Seto WH, et al. Preliminary findings of a randomized trial of non-pharmaceutical interventions to prevent influenza transmission in households. PLoS One. 2008 May 7;3(5):e2101. Lee LY, Lam EP, Chan CK, Chan SY, Chiu MK, Chong WH, et al. Practice and technique of using face mask amongst adults in the community: a cross-sectional descriptive study. BMC Public Health. 2020 Jun 16;20(1):948. Zayas G, Chiang MC, Wong E, MacDonald F, Lange CF, Senthilselvan A, et al. Effectiveness of cough etiquette maneuvers in disrupting the chain of transmission of infectious respiratory diseases. BMC Public Health. 2013 Sep 8;13:811.
Leung NHL, Chu DKW, Shiu EYC, Chan KH, McDevitt JJ, Hau BJP, et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med. 2020 05;26(5):676-80.