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Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks


The CDC recommends that healthcare settings provide influenza patients with facemasks as a means of reducing transmission to staff and other patients, and a recent report suggested that surgical masks can capture influenza virus in large droplet spray. However, there is minimal data on influenza virus aerosol shedding, the infectiousness of exhaled aerosols, and none on the impact of facemasks on viral aerosol shedding from patients with seasonal influenza.

We collected samples of exhaled particles (one with and one without a facemask) in two size fractions (“coarse”>5 µm, “fine”≤5 µm) from 37 volunteers within 5 days of seasonal influenza onset, measured viral copy number using quantitative RT-PCR, and tested the fine-particle fraction for culturable virus.

Fine particles contained 8.8 (95% CI 4.1 to 19) fold more viral copies than did coarse particles. Surgical masks reduced viral copy numbers in the fine fraction by 2.8 fold (95% CI 1.5 to 5.2) and in the coarse fraction by 25 fold (95% CI 3.5 to 180). Overall, masks produced a 3.4 fold (95% CI 1.8 to 6.3) reduction in viral aerosol shedding. Correlations between nasopharyngeal swab and the aerosol fraction copy numbers were weak (r = 0.17, coarse; r = 0.29, fine fraction). Copy numbers in exhaled breath declined rapidly with day after onset of illness. Two subjects with the highest copy numbers gave culture positive fine particle samples.

Surgical masks worn by patients reduce aerosols shedding of virus. The abundance of viral copies in fine particle aerosols and evidence for their infectiousness suggests an important role in seasonal influenza transmission. Monitoring exhaled virus aerosols will be important for validation of experimental transmission studies in humans.


Vyšlo v časopise: Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks. PLoS Pathog 9(3): e32767. doi:10.1371/journal.ppat.1003205
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.ppat.1003205

Souhrn

The CDC recommends that healthcare settings provide influenza patients with facemasks as a means of reducing transmission to staff and other patients, and a recent report suggested that surgical masks can capture influenza virus in large droplet spray. However, there is minimal data on influenza virus aerosol shedding, the infectiousness of exhaled aerosols, and none on the impact of facemasks on viral aerosol shedding from patients with seasonal influenza.

We collected samples of exhaled particles (one with and one without a facemask) in two size fractions (“coarse”>5 µm, “fine”≤5 µm) from 37 volunteers within 5 days of seasonal influenza onset, measured viral copy number using quantitative RT-PCR, and tested the fine-particle fraction for culturable virus.

Fine particles contained 8.8 (95% CI 4.1 to 19) fold more viral copies than did coarse particles. Surgical masks reduced viral copy numbers in the fine fraction by 2.8 fold (95% CI 1.5 to 5.2) and in the coarse fraction by 25 fold (95% CI 3.5 to 180). Overall, masks produced a 3.4 fold (95% CI 1.8 to 6.3) reduction in viral aerosol shedding. Correlations between nasopharyngeal swab and the aerosol fraction copy numbers were weak (r = 0.17, coarse; r = 0.29, fine fraction). Copy numbers in exhaled breath declined rapidly with day after onset of illness. Two subjects with the highest copy numbers gave culture positive fine particle samples.

Surgical masks worn by patients reduce aerosols shedding of virus. The abundance of viral copies in fine particle aerosols and evidence for their infectiousness suggests an important role in seasonal influenza transmission. Monitoring exhaled virus aerosols will be important for validation of experimental transmission studies in humans.


Zdroje

1. FabianP, McDevittJJ, DeHaanWH, FungRO, CowlingBJ, et al. (2008) Influenza virus in human exhaled breath: an observational study. PLoS ONE 3: e2691.

2. JohnsonGR, MorawskaL (2009) The Mechanism of Breath Aerosol Formation. J Aerosol Med Pulm Drug Deliv 22: 229–37.

3. Committee on Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A (2009) Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A: A Letter Report. Washington, DC: Institute of Medicine. 60 p.

4. AtkinsonMP, WeinLM (2008) Quantifying the routes of transmission for pandemic influenza. Bull Math Biol 70: 820–867.

5. NicasM, JonesRM (2009) Relative contributions of four exposure pathways to influenza infection risk. Risk Anal 29: 1292–1303.

6. MorawskaL (2006) Droplet fate in indoor environments, or can we prevent the spread of infection? Indoor Air 16: 335–347.

7. BrankstonG, GittermanL, HirjiZ, LemieuxC, GardamM (2007) Transmission of influenza A in human beings. Lancet Infect Dis 7: 257–265.

8. TellierR (2006) Review of aerosol transmission of influenza A virus. Emerg Infect Dis 1657–1662.

9. Committee on Personal Protective Equipment for Healthcare Personnel to Prevent Transmission of Pandemic Influenza and Other Viral Respiratory Infections: Current Research Issues Institute of Medicine (2011) Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Workers Update 2010; Larson EL, Liverman CT, editors: The National Academies Press.

10. Centers for Disease Control and Prevention (2011) RFA IP-11-001 Virologic evaluation of the modes of influenza virus transmission among humans. http://grants.gov. Accessed 14 October 2012.

11. KillingleyB, EnstoneJE, GreatorexJ, GilbertAS, Lambkin-WilliamsR, et al. (2012) Use of a human influenza challenge model to assess person-to-person transmission: proof-of-concept study. J Infect Dis 205: 35–43.

12. AlfordRH, KaselJA, GeronePJ, KnightV (1966) Human influenza resulting from aerosol inhalation. Proc Soc Exp Biol Med 122: 800–804.

13. Levy BS, Wegman DH, Barron SL, Sokas RK (2005) Occupational health : recognizing and preventing work-related disease and injury. Philadelphia: Lippincott Williams & Wilkins. 847 p.

14. Centers for Disease Control and Prevention (2009) Interim Guidance for Novel H1N1 Flu (Swine Flu): Taking Care of a Sick Person in Your Home. Centers for Disease Control and Prevention. http://www.cdc.gov/h1n1flu/guidance_homecare.htm Accessed 11 February 2010.

15. Centers for Disease Control and Prevention (2009) Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission. http://www.cdc.gov/h1n1flu/masks.htm Accessed 11 February 2010.

16. JohnsonDF, DruceJD, BirchC, GraysonML (2009) A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. Clin Infect Dis 49: 275–277.

17. Centers for Disease Control and Prevention (2010) Prevention strategies for seasonal influenza in healthcare settings. http://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm. Accessed 2 October 2012.

18. ObergT, BrosseauLM (2008) Surgical mask filter and fit performance. Am J Infect Control 36: 276–282.

19. BoellePY, AnsartS, CoriA, ValleronAJ (2011) Transmission parameters of the A/H1N1 (2009) influenza virus pandemic: a review. Influenza Other Respi Viruses 5: 306–316.

20. BrienenNC, TimenA, WallingaJ, van SteenbergenJE, TeunisPF (2010) The effect of mask use on the spread of influenza during a pandemic. Risk Anal 30: 1210–1218.

21. CowlingBJ, ChanKH, FangVJ, ChengCK, FungRO, et al. (2009) Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households: A Randomized Trial. Ann Intern Med 151: 437–46.

22. RadonovichLJJr, ChengJ, ShenalBV, HodgsonM, BenderBS (2009) Respirator tolerance in health care workers. JAMA 301: 36–38.

23. LindsleyWG, BlachereFM, ThewlisRE, VishnuA, DavisKA, et al. (2010) Measurements of airborne influenza virus in aerosol particles from human coughs. PLoS One 5: e15100.

24. TellierR (2009) Aerosol transmission of influenza A virus: a review of new studies. J R Soc Interface 6 Suppl 6: S783–790.

25. LangmuirAD (1980) Changing concepts of airborne infection of acute contagious diseases: a reconsideration of classic epidemiologic theories. Ann N Y Acad Sci 353: 35–44.

26. FabianP, McDevittJJ, HousemanEA, MiltonDK (2009) Airborne influenza virus detection with four aerosol samplers using molecular and infectivity assays: considerations for a new infectious virus aerosol sampler. Indoor Air 19: 433–441.

27. McDevittJJ, KoutrakisP, FergusonST, WolfsonJM, FabianMP, et al. (2013) Development and performance evaluation of an exhaled-breath bioaerosol collector for influenza virus. Aerosol Sci Tech DOI 10.1080/02786826.2012.762973.

28. KillingleyB, EnstoneJ, BooyR, HaywardA, OxfordJ, et al. (2011) Potential role of human challenge studies for investigation of influenza transmission. Lancet Infect Dis 11: 879–886.

29. CarratF, VerguE, FergusonNM, LemaitreM, CauchemezS, et al. (2008) Time lines of infection and disease in human influenza: a review of volunteer challenge studies. Am J Epidemiol 167: 775–785.

30. RobertsMG, NishiuraH (2011) Early Estimation of the Reproduction Number in the Presence of Imported Cases: Pandemic Influenza H1N1-2009 in New Zealand. Plos One 6.

31. Lloyd-SmithJO, SchreiberSJ, KoppPE, GetzWM (2005) Superspreading and the effect of individual variation on disease emergence. Nature 438: 355–359.

32. FabianP, McDevittJJ, LeeWM, HousemanEA, MiltonDK (2009) An optimized method to detect influenza virus and human rhinovirus from exhaled breath and the airborne environment. J Environ Monit 11: 314–317.

33. van EldenLJ, NijhuisM, SchipperP, SchuurmanR, van LoonAM (2001) Simultaneous detection of influenza viruses A and B using real-time quantitative PCR. J Clin Microbiol 39: 196–200.

Štítky
Hygiena a epidemiológia Infekčné lekárstvo Laboratórium

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