Evidence for airborne infectious disease transmission in public ground transport – a literature review

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Evidence for airborne infectious disease transmission in public ground transport--a literature review

While guidelines on contact tracing (CT) after exposure to certain infectious pathogens during air travel exist, no guidance documents are available on CT in response to potential exposure on public ground transport. We reviewed scientific and non-scientific literature on transmission of airborne pathogens in public ground transport and on factors potentially influencing transmission. We identified 32 relevant publications (15 scientific and 17 non-scientific). Most of the selected studies dealt with transmission of tuberculosis. However, the relation between travel duration, proximity to the index case and environmental factors, such as ventilation, on disease transmission in public ground transport is poorly understood. Considering the difficulty and probably limited effectiveness of CT in ground transport, our results suggest that only exceptional circumstances would justify CT. This contrasts with the high level of attention CT in air travel seems to receive in international regulations and recommendations. We question whether the indication for CT should be revisited after a risk–benefit assessment that takes into account exposure in both ground and air transport.

Quantitative assessment of passenger flows in Europe and its implications for tracing contacts of infectious passengers

In contrast to air travel, there are no recommendations on tracing ground transport passengers exposed to infectious pathogens. We analysed European statistics on passenger transport in different conveyances and conducted expert workshops to discuss environmental conditions in ground transport, indications and minimal datasets required for contact tracing. Transport performance in the 27 countries of the European Union increased from 5.3x1012 passenger kilometres (pkm) in 1995 to 6.5x1012 pkm in 2007. Each resident generated on average 13,092 pkm in 2007, of which 2,062 pkm were public ground transport and 1,155 pkm in air transport. In the same year in Germany the total passenger volume in all different conveyances was 67,937 million. Public ground transport accounted for a passenger volume of 11,387 million (16.8%) and air transport for 129 million (0.2%). High efficiency particulate air (HEPA) filtration is frequently used in airplanes but not in ground transport vehicles. Therefore opportunities for disease transmission in public ground transport are not necessarily lower than in air travel. However, contact tracing is rarely conducted in these settings because of immense logistic challenges. Indication for contact tracing should be revisited, including all kinds of passenger transport.

Identification of three MICA alleles in the genotype of a patient with chronic lymphocytic leukemia

Major histocompatibility complex (MHC) class I-related chain A gene (MICA) sequence-based genotyping (SBT) was attempted on a peripheral blood sample collected from a patient evaluated for hematopoietic stem cell retransplant. The electropherogram pattern of MICA SBT indicated the possibility of carrying more than two MICA alleles. Subsequent cloning and sequencing of the polymerase chain reaction products revealed the presence of three distinct MICA alleles: MICA*008:01/:04 (A5.1), MICA*007:01(A4), and MICA*002:01 (A9) in the genotype of this patient. The origin of the third extra MICA allele could not be determined and would require MICA genotyping information from other family members, which is unavailable.

Description of two new MICA alleles: MICA*058 and MICA*002:03

We describe two novel alleles, MICA*058 and MICA* 002:03.

Update on the ongoing outbreak of haemolytic uraemic syndrome due to Shiga toxin-producing Escherichia coli (STEC) serotype O104, Germany, May 2011

Since early May 2011, a large outbreak of haemolytic uraemic syndrome (HUS) and bloody diarrhoea related to infections with Shiga toxin-producing Escherichia coli (STEC) has been observed in Germany. The outbreak is focused in the north, but cases have been reported from all German states and other countries. Since our report last week, the number of HUS cases has increased to 470 and STEC serotype O104 has been confirmed in many cases.

Large and ongoing outbreak of haemolytic uraemic syndrome, Germany, May 2011

Since early May 2011, an increased incidence of haemolytic uraemic syndrome (HUS) and bloody diarrhoea related to infections with Shiga toxin-producing Escherichia coli (STEC) has been observed in Germany, with most cases in the north of the country. Cases reported from other European countries had travelled to this area. First results of a case–control study conducted in Hamburg suggest an association between the occurrence of disease and the consumption of raw tomatoes, cucumber and leaf salad.

Large and ongoing outbreak of haemolytic uraemic syndrome, Germany, May 2011

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Allotransplantation of cryopreserved parathyroid tissue for severe hypocalcemia in a renal transplant recipient

We report the successful allotransplantation of cryopreserved parathyroid tissue to reverse hypocalcemia in a kidney transplant recipient. A 36-year-old male received a second deceased donor kidney transplant, and 6 weeks later developed severe bilateral leg numbness and weakness, inability to walk, acute pain in the left knee and wrist tetany. His total calcium was 2.6 mg/dL and parathormone level 5 pg/mL (normal 10-60 pg/mL). He underwent allotransplantation of parathyroid tissue cryopreserved for 8 months into his left brachioradialis muscle. Immunosuppression included tacrolimus (target C(0) 10-12 ng/mL), mycophenolate mofetil and steroids. Within 2 weeks, the left knee pain, leg weakness and numbness resolved, and by 1 month he could walk normally. After a peak at month 2, his parathyroid hormone (PTH) level fell to <10 pg/mL; therefore at month 3 he received a second parathyroid transplant from the same donor. Eight months later (11 months after initial graft) he has a total calcium of 9.3 mg/dL, PTH level 15 pg/mL and is clinically asymptomatic. The amount of parathyroid tissue needed to render a patient normocalcemic is not known. In our case, the need for second transplant suggests that the amount of tissue transferred for an allograft may need to be substantially greater than for an autograft.

Influence of killer immunoglobulin-like receptor/HLA ligand matching on achievement of T-cell complete donor chimerism in related donor nonmyeloablative allogeneic hematopoietic stem cell transplantation

Achievement of complete donor chimerism (CDC) after allogeneic nonmyeloablative hematopoietic stem cell transplantation (NMHSCT) is important for preventing graft rejection and for generating a graft-vs-malignancy effect. The alloreactivity of NK cells and some T-cell subsets is mediated through the interaction of their killer immunoglobulin-like receptors (KIRs) with target cell HLA/KIR ligands. The influence of KIR matching on the achievement of T-cell CDC after NMHSCT has not been previously described. We analyzed 31 patients undergoing T-cell replete related donor NMHSCT following fludarabine and 200 cGy TBI. Recipient inhibitory KIR genotype and donor HLA/KIR ligand matches were used to generate an inhibitory KIR score from 1 to 4 based upon the potential number of recipient inhibitory KIRs that could be engaged with donor HLA/KIR ligands. Patients with a score of 1 were less likely to achieve T-cell CDC (P=0.016) and more likely to develop graft rejection (P=0.011) than those with scores greater than 1. Thus, patients with lower inhibitory KIR scores may have more active anti-donor immune effector cells that may reduce donor chimerism. Conversely, patients with greater inhibitory KIR scores may have less active NK cell and T-cell populations, which may make them more likely to achieve CDC.