A few cautious Americans wear surgical masks or high-filtering, tighter-fitting face masks called respirators in public places to prevent contracting the novel H1N1 virus, but they are not prevalent.

The U.S. Centers for Disease Control and Prevention has reported 9,079 swine flu hospitalizations and 593 deaths as of Aug. 30.

Before people knew how disease spread, the cautious sometimes turned to masks. During the bubonic plague, masks filled with medicinal herbs looked like giant bird beaks.

During the worldwide Spanish flu pandemic of 1918-19, the Sun Herald of Biloxi, Miss., reported the Gulf Coast district's head health officer, Leslie C. Frank, issued an order that "all clerks and other persons waiting on or serving the public . . . are urgently requested to wear masks. The public generally are also requested to wear said masks . . ."

For swine flu, the CDC doesn't currently recommend mask precautions. Masks are urged only for those with confirmed flu if they share common household space or if they must be in the public.

Contrast this U.S. picture to countries such as Japan, where wearing a face mask as a preventive measure has been part of the culture for decades.

Instead of masks, the CDC recommends following basic hygiene rules, which include washing hands frequently or using alcohol-based hand sanitizer, covering mouths and noses with tissue, avoiding touching nose and mouth and staying home to keep from spreading the flu.

"We use CDC to give us most of our recommendations and we modify them with what's going on in our state," said Dr. Paul Byers, medical director of the epidemiology program at Mississippi State Department of Health, which has reported 838 swine flu cases as of this week.

"We do have fairly widespread influenza activity in the state, unusual for this time of year. Face-mask wearing at this point is not a recommended way to avoid contracting the flu. But this is a fluid situation, and it is difficult to predict what direction the (mask) recommendations will go in.

"I want to stress that the most important way to prevent flu is through routine respiratory and hygiene measures, and please get the vaccine," he said.

The swine flu vaccine should be available by mid-October, first for high-risk patients and then to the general public as supplies allow. Until then the best prevention, other health professionals echo, is hygiene.

"It's difficult to assess the essential effectiveness of a face mask, so it all goes back to avoiding flu situations," said Mary Harris, Hancock (Miss.) Medical Center family nurse practitioner.

"Social distancing is effective, as well as keeping space — 6 feet is recommended — between you and a coughing person," said Annette Biksey, infection preventionist at Memorial Hospital at Gulfport.

Virus-laden droplets from coughs and sneezes spread the flu, both Harris and Biksey said. That's why emergency rooms and some doctors' offices follow CDC guidelines by offering waiting-room patients surgical masks and sanitizers.

Those with lung or respiratory problems may not tolerate masks, and because masks must be replaced after each use, supply and cost are also deterrents for widespread use.