Protect yourself against flu: Learn more about preventive measures

Personal measures for protecting yourself

1. Avoid close contact with sick people

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 respiratory or other virus.

• Avoid crowded settings, particularly if indoors. 
• Avoid contact with sick people, if possible, particularly if you have underlying health problems (e.g. a lung or heart condition, or weakened immune system. If you cannot avoid this, maintain a distance of at least one to two metres from someone with symptoms of influenza. 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. You may also wear a face mask, preferably a respirator (filtering facepiece FFP2). 
• When caring for and being in close contact with people who may have influenza, minimise close contact and use a face mask, preferably a respirator FFP2 (please see separate chapter below).

2. Wash or clean your hands frequently

• Hand hygiene is commonly performed by washing hands with soap and water, or by applying alcohol-based hand rub.  Both are easily accessible, available, affordable, and well-accepted in most communities. Washing or disinfecting your hands often (e.g. after being in public spaces/transport, before eating, after coughing or sneezing) will help protect you from a number of infections, including influenza. 
• When caring for someone who may have influenza, make sure to wash your hands after touching them and after handling their used tissues, personal items or laundry.
• Washing hands should not be just a quick rinse; it should go on for at least 20 seconds every time.
• After washing with soap and water, dry your hands thoroughly.  

3. Avoid touching your eyes, nose or mouth

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

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 proper hand hygiene. Cough etiquette includes turning the head and covering the mouth when coughing or sneezing into a sleeve or elbow, rather than a hand. The rationale for not coughing into the hands is to prevent subsequent contamination of other surfaces or objects through the hands. Tissues should be thrown in a lidded bin after use.

2. Wash or clean your hands frequently

• Hand hygiene is commonly performed with soap and water or alternatively with alcohol-based hand rub, both of which are easily accessible, available and affordable. Washing or disinfecting your hands often will help protect others from your germs. Wash your hands thoroughly with soap and water, especially after handling your used tissues after coughing or sneezing.
• Washing hands should not be just a quick rinse; it should go on for at least 20 seconds each time.
• After washing with soap and water, dry your hands thoroughly. 

3. Environmental measures

3.1 Surface and object cleaning

Given that influenza and other respiratory viruses can survive on some surfaces for prolonged periods, cleaning or disinfection can effectively reduce or inactivate them from surfaces and objects. Increase the frequency of cleaning frequently touched surfaces (e.g. door handles, keyboards, screens, etc) with soap and water or alcohol wipes as per the manufacturer’s instructions for electronic equipment. 

3.2 Increased ventilation

Increased ventilation is considered helpful in reducing transmission. Studies have predicted a reduction of transmission of influenza when doubling or tripling the ventilation rate in a closed space. Therefore, adequate ventilation with outdoor air is recommended in all settings to reduce the transmission of influenza and other respiratory infections. Examples include opening windows frequently or ensuring ventilation systems are functioning properly (when such systems are installed).

4. Stay home from work or school and limit contact with others if you are sick

In addition to the hygiene measures described above, people who are diagnosed with influenza by a physician or who have respiratory symptoms with or without fever during a period of increased influenza activity in the community should remain at home, if possible, at least 4-5 days after symptoms onset to avoid exposing other people. Usually, adults who are sick can infect others for approximately one day before and five days after symptoms start, and children for approximately seven days after symptoms start, although the contagious period can vary depending on several factors (e.g. individual's immune response and the virus). 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, they should consider wearing a medical face mask or FFP2 respirator in public places when they may have close contact with others. If possible, a distance of at least one to two metres should be kept if anyone has symptoms of influenza. 

Wearing a face mask when appropriate, as discussed below. 

Face masks

During periods of high community transmission of respiratory viruses such as SARS-CoV-2, influenza and RSV, ECDC recommends the use of face masks by healthcare staff, visitors and patients in primary and secondary healthcare settings. In addition,  a facemask (or preferably an FFP2 respirator) is recommended for elderly persons or persons with underlying health conditions in confined public spaces, such as stores, supermarkets, transportation hubs and when using public transport.

A facemask should be used correctly to achieve the desired effect. Studies have shown that respirators (FFP2) are more effective than medical facemasks in filtering infectious droplets both exhaled by an infected person or inhaled by close contacts.

If used correctly, face masks can help reduce the risk of infection due to exposure to infectious droplets and aerosol, particularly if 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

People with influenza-like symptoms should isolate and avoid close contact with other people. If this is not possible, the use of a facemask by people who are ill with influenza symptoms may help contain infectious respiratory secretions when the person coughs or sneezes and lower the risk for infection among close contacts. Situations where this may be useful include:

• when travelling home, to/from a hospital or medical appointment after developing symptoms;
• 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);
• when otherwise unavoidably having close contact with healthy people; and
• when symptomatic 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

People who are well for whom a facemask may provide additional protection include:

• Family members or other household contacts or other non-healthcare settings providing care for someone with influenza symptoms and who must have close contact (within one metre).
• Caregivers of persons with symptoms using a nebulizer for respiratory medication.
• Healthy people entering a hospital as visitors 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:

• Clean your hands with soap and water or hand sanitiser before touching the mask.
• Remove a mask or respirator from the box and make sure there are no obvious tears or holes in either side of the mask.
• 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).
• Ensure that the part with the metal strip is on the upper side, as it is intended to fit over your nose.
• Follow the instructions below for the type of mask you are using:
  •    Face mask with ear loops: Hold the mask or respirator 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 it with a bow.
  •    Respirator with bands: Hold the mask in your hand with the metal nosepiece or top of the mask at your fingertips, allowing the headbands to hang freely below your 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.
• Press firmly on the metal strip so that it follows the shape of the bridge of the nose and face.
• Make sure that the facemask or respirator covers the nose, mouth and chin. 
• Avoid touching the facemask or respirator 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.

After prolonged use (e.g. longer than two to four hours), facemasks may become damp/humid making breathing difficult.  They should be replaced by a new or a clean, dry facemask. Respirators can be used safely for at least four hours. They can be used repeatedly for short periods of time if they are stored safely (e.g. in a clean paper bag), if not they should be discarded.  Do not reuse single-use masks. 

3. Properly remove and dispose of a face mask:

• Clean your hands with soap and water or hand sanitiser 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.
• 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.
  •    Respirator with bands: Lift the bottom strap over your head first, then pull the top strap over your head.
   
• Do not allow the used mask or respirator to touch or contaminate surfaces or clothes
• Dispose of the used facemask or respirator in a plastic or paper bag or a lidded bin.
• Clean your hands with soap and water or hand sanitiser. 

Background and evidence for these recommendations

Personal protective measures for reducing the risk of acquiring or transmitting human influenza

ECDC Considerations for the use of face masks in the community in the context of the SARS-CoV-2 Omicron variant of concern

Interim Public Health Guidance for the Use of Face masks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic (link is external)

U.S. CDC Interim Recommendations for Face mask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected(link is external)

Centers for Disease Control and Prevention. Respiratory hygiene/cough etiquette in healthcare settings, 2009(link is external)

Centers for Disease Control and Prevention. Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR 2010;59(No. RR-8)(link is external)

Public Health England, Department of Health. The Use of Face masks and Respirators during an Influenza Pandemic: Scientific Evidence Base Review, 2014.(link is external)

Centers for Disease Control and Prevention. Interim Guidance for the Use of Masks to Control Seasonal Influenza Virus Transmission, 2019(link is external)

Centre for Health Protection.(link is external) Use mask properly protect ourselves and protect others. 2019.

World Health Organization. Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza, 2019(link is external)

European Centre for Disease Control and Prevention. Considerations for the use of face masks in the community in the context of the SARS-CoV-2 Omicron variant of concern, 2022

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.