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SARS-CoV-2 in the Air Surrounding Patients during Nebulizer Therapy. CANADIAN JOURNAL OF INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY 2022; 2022:9297974. [PMID: 36213437 PMCID: PMC9536972 DOI: 10.1155/2022/9297974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022]
Abstract
Nebulizer therapy is commonly used for patients with obstructive pulmonary disease or acute pulmonary infections with signs of obstruction. It is considered a “potential aerosol-generating procedure,” and the risk of disease transmission to health care workers is uncertain. The aim of this pilot study was to assess whether nebulizer therapy in hospitalized COVID-19 patients is associated with increased dispersion of SARS-CoV-2. Air samples collected prior to and during nebulizer therapy were analyzed by RT-PCR and cell culture. Total aerosol particle concentrations were also quantified. Of 13 patients, seven had quantifiable virus in oropharynx samples, and only two had RT-PCR positive air samples. For both these patients, air samples collected during nebulizer therapy had higher SARS-CoV-2 RNA concentrations compared to control air samples. Also, for particle sizes 0.3–5 µm, particle concentrations were significantly higher during nebulizer therapy than in controls. We were unable to cultivate virus from any of the RT-PCR positive air samples, and it is therefore unknown if the detected virus were replication-competent; however, the significant increase in smaller particles, which can remain airborne for extended periods of time, and increased viral RNA concentrations during treatment may indicate that nebulizer therapy is associated with increased risk of SARS-CoV-2 transmission.
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102
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Genome Sequence of Genotype 1A Hepatovirus A Isolated from Plasma from a Haitian Child. Microbiol Resour Announc 2022; 11:e0044922. [PMID: 35950865 PMCID: PMC9476952 DOI: 10.1128/mra.00449-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Genotype 1A hepatovirus A was identified by quantitative reverse transcription-PCR and isolated from plasma from a Haitian child with acute undifferentiated febrile illness and malaise. The strain was most closely related to Brazilian strains, consistent with recognized patterns of virus movement in the Caribbean region.
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103
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da Silva SJR, do Nascimento JCF, Germano Mendes RP, Guarines KM, Targino Alves da Silva C, da Silva PG, de Magalhães JJF, Vigar JRJ, Silva-Júnior A, Kohl A, Pardee K, Pena L. Two Years into the COVID-19 Pandemic: Lessons Learned. ACS Infect Dis 2022; 8:1758-1814. [PMID: 35940589 PMCID: PMC9380879 DOI: 10.1021/acsinfecdis.2c00204] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and virulent human-infecting coronavirus that emerged in late December 2019 in Wuhan, China, causing a respiratory disease called coronavirus disease 2019 (COVID-19), which has massively impacted global public health and caused widespread disruption to daily life. The crisis caused by COVID-19 has mobilized scientists and public health authorities across the world to rapidly improve our knowledge about this devastating disease, shedding light on its management and control, and spawned the development of new countermeasures. Here we provide an overview of the state of the art of knowledge gained in the last 2 years about the virus and COVID-19, including its origin and natural reservoir hosts, viral etiology, epidemiology, modes of transmission, clinical manifestations, pathophysiology, diagnosis, treatment, prevention, emerging variants, and vaccines, highlighting important differences from previously known highly pathogenic coronaviruses. We also discuss selected key discoveries from each topic and underline the gaps of knowledge for future investigations.
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Affiliation(s)
- Severino Jefferson Ribeiro da Silva
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil.,Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Jessica Catarine Frutuoso do Nascimento
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
| | - Renata Pessôa Germano Mendes
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
| | - Klarissa Miranda Guarines
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
| | - Caroline Targino Alves da Silva
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
| | - Poliana Gomes da Silva
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
| | - Jurandy Júnior Ferraz de Magalhães
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil.,Department of Virology, Pernambuco State Central Laboratory (LACEN/PE), 52171-011 Recife, Pernambuco, Brazil.,University of Pernambuco (UPE), Serra Talhada Campus, 56909-335 Serra Talhada, Pernambuco, Brazil.,Public Health Laboratory of the XI Regional Health, 56912-160 Serra Talhada, Pernambuco, Brazil
| | - Justin R J Vigar
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Abelardo Silva-Júnior
- Institute of Biological and Health Sciences, Federal University of Alagoas (UFAL), 57072-900 Maceió, Alagoas, Brazil
| | - Alain Kohl
- MRC-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, United Kingdom
| | - Keith Pardee
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada.,Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8, Canada
| | - Lindomar Pena
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
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104
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Linde KJ, Wouters IM, Kluytmans JAJW, Kluytmans-van den Bergh MFQ, Pas SD, GeurtsvanKessel CH, Koopmans MPG, Meier M, Meijer P, Raben CR, Spithoven J, Tersteeg-Zijderveld MHG, Heederik DJJ, Dohmen W. Detection of SARS-CoV-2 in Air and on Surfaces in Rooms of Infected Nursing Home Residents. Ann Work Expo Health 2022; 67:129-140. [PMID: 36068657 PMCID: PMC9834894 DOI: 10.1093/annweh/wxac056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/12/2022] [Accepted: 07/29/2022] [Indexed: 01/14/2023] Open
Abstract
There is an ongoing debate on airborne transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) as a risk factor for infection. In this study, the level of SARS-CoV-2 in air and on surfaces of SARS-CoV-2 infected nursing home residents was assessed to gain insight in potential transmission routes. During outbreaks, air samples were collected using three different active and one passive air sampling technique in rooms of infected patients. Oropharyngeal swabs (OPS) of the residents and dry surface swabs were collected. Additionally, longitudinal passive air samples were collected during a period of 4 months in common areas of the wards. Presence of SARS-CoV-2 RNA was determined using RT-qPCR, targeting the RdRp- and E-genes. OPS, samples of two active air samplers and surface swabs with Ct-value ≤35 were tested for the presence of infectious virus by cell culture. In total, 360 air and 319 surface samples from patient rooms and common areas were collected. In rooms of 10 residents with detected SARS-CoV-2 RNA in OPS, SARS-CoV-2 RNA was detected in 93 of 184 collected environmental samples (50.5%) (lowest Ct 29.5), substantially more than in the rooms of residents with negative OPS on the day of environmental sampling (n = 2) (3.6%). SARS-CoV-2 RNA was most frequently present in the larger particle size fractions [>4 μm 60% (6/10); 1-4 μm 50% (5/10); <1 μm 20% (2/10)] (Fischer exact test P = 0.076). The highest proportion of RNA-positive air samples on room level was found with a filtration-based sampler 80% (8/10) and the cyclone-based sampler 70% (7/10), and impingement-based sampler 50% (5/10). SARS-CoV-2 RNA was detected in 10 out of 12 (83%) passive air samples in patient rooms. Both high-touch and low-touch surfaces contained SARS-CoV-2 genome in rooms of residents with positive OPS [high 38% (21/55); low 50% (22/44)]. In one active air sample, infectious virus in vitro was detected. In conclusion, SARS-CoV-2 is frequently detected in air and on surfaces in the immediate surroundings of room-isolated COVID-19 patients, providing evidence of environmental contamination. The environmental contamination of SARS-CoV-2 and infectious aerosols confirm the potential for transmission via air up to several meters.
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Affiliation(s)
- Kimberly J Linde
- Author to whom correspondence should be addressed. Tel: +31302535358; e-mail:
| | - Inge M Wouters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jan A J W Kluytmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marjolein F Q Kluytmans-van den Bergh
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | - Suzan D Pas
- Microvida Location Amphia/Bravis, Breda/Roosendaal, The Netherlands
| | | | | | | | - Patrick Meijer
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ceder R Raben
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jack Spithoven
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Dick J J Heederik
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Wietske Dohmen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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105
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Vass WB, Lednicky JA, Shankar SN, Fan ZH, Eiguren-Fernandez A, Wu CY. Viable SARS-CoV-2 Delta variant detected in aerosols in a residential setting with a self-isolating college student with COVID-19. JOURNAL OF AEROSOL SCIENCE 2022; 165:106038. [PMID: 35774447 PMCID: PMC9217630 DOI: 10.1016/j.jaerosci.2022.106038] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 05/08/2023]
Abstract
The B.1.617.2 (Delta) variant of SARS-CoV-2 emerged in India in October of 2020 and spread widely to over 145 countries, comprising over 99% of genome sequence-confirmed virus in COVID-19 cases of the United States (US) by September 2021. The rise in COVID-19 cases due to the Delta variant coincided with a return to in-person school attendance, straining COVID-19 mitigation plans implemented by educational institutions. Some plans required sick students to self-isolate off-campus, resulting in an unintended consequence: exposure of co-inhabitants of dwellings used by the sick person during isolation. We assessed air and surface samples collected from the bedroom of a self-isolating university student with mild COVID-19 for the presence of SARS-CoV-2. That virus' RNA was detected by real-time reverse-transcription quantitative polymerase chain reaction (rRT-qPCR) in air samples from both an isolation bedroom and a distal, non-isolation room of the same dwelling. SARS-CoV-2 was detected and viable virus was isolated in cell cultures from aerosol samples as well as from the surface of a mobile phone. Genomic sequencing revealed that the virus was a Delta variant SARS-CoV-2 strain. Taken together, the results of this work confirm the presence of viable SARS-CoV-2 within a residential living space of a person with COVID-19 and show potential for transportation of virus-laden aerosols beyond a designated isolation suite to other areas of a single-family home.
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Affiliation(s)
- William B Vass
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, FL, USA
| | - John A Lednicky
- Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Sripriya Nannu Shankar
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, FL, USA
| | - Z Hugh Fan
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL, 32611, USA
- Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, 32611, USA
| | | | - Chang-Yu Wu
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, FL, USA
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106
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Gartland N, Fishwick D, Coleman A, Davies K, Hartwig A, Johnson S, van Tongeren M. Transmission and control of SARS-CoV-2 on ground public transport: A rapid review of the literature up to May 2021. JOURNAL OF TRANSPORT & HEALTH 2022; 26:101356. [PMID: 35261878 PMCID: PMC8894738 DOI: 10.1016/j.jth.2022.101356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND During a pandemic, public transport is strategically important for keeping the country going and getting people where they need to be. The essential nature of public transport puts into focus the risk of transmission of SARS-CoV-2 in this sector; rapid and diverse work has been done to attempt to understand how transmission happens in this context and what factors influence risk. OBJECTIVES This review aimed to provide a narrative overview of the literature assessing transmission, or potential for transmission, of SARS-CoV-2 on ground-based public transport, as well as studies assessing the effectiveness of control measures on public transport during the early part of the pandemic (up to May 2021). METHODS An electronic search was conducted using Web of Science, Ovid, the Cochrane Library, ProQuest, Pubmed, and the WHO global COVID database. Searches were run between December 2020 and May 2021. RESULTS The search strategy identified 734 papers, of which 28 papers met the inclusion criteria for the review; 10 papers assessed transmission of SARS-CoV-2, 11 assessed control measures, and seven assessed levels of contamination. Eleven papers were based on modelling approaches; 17 studies were original studies reporting empirical COVID-19 data. CONCLUSIONS The literature is heterogeneous, and there are challenges for measurement of transmission in this setting. There is evidence for transmission in certain cases, and mixed evidence for the presence of viral RNA in transport settings; there is also evidence for some reduction of risk through mitigation. However, the routes of transmission and key factors contributing to transmission of SARS-CoV-2 on public transport were not clear during the early stage of the pandemic. Gaps in understanding are discussed and six key questions for future research have been posed. Further exploration of transmission factors and effectiveness of mitigation strategies is required in order to support decision making.
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Affiliation(s)
- Nicola Gartland
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - David Fishwick
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Anna Coleman
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Karen Davies
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Angelique Hartwig
- Alliance Manchester Business School, University of Manchester, Manchester, United Kingdom
| | - Sheena Johnson
- Alliance Manchester Business School, University of Manchester, Manchester, United Kingdom
| | - Martie van Tongeren
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
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107
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Del Álamo C, Vázquez-Calvo Á, Alcamí A, Sánchez-García-Casarrubios J, Pérez-Díaz JL. Assessment of Surface Disinfection Effectiveness of Decontamination System COUNTERFOG® SDR-F05A+ Against Bacteriophage ɸ29. FOOD AND ENVIRONMENTAL VIROLOGY 2022; 14:304-313. [PMID: 35851946 PMCID: PMC9294796 DOI: 10.1007/s12560-022-09526-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/24/2022] [Indexed: 05/14/2023]
Abstract
The experience of COVID19 pandemic has demonstrated the real concern of biological agents dispersed in the air and surfaces environments. Therefore, the need of a fast and large-scale disinfection method has arisen for prevention of contagion. COUNTERFOG® is an innovative technology developed for large-scale decontamination of air and surfaces. The objective of this study is to assess experimentally the effectiveness of COUNTERFOG® in disinfecting viral-contaminated surfaces. We also aim to measure the necessary time to disinfect said surfaces. Stainless steel surfaces were contaminated with bacteriophage φ29 and disinfected using COUNTERFOG® SDR-F05A+, which uses a sodium hypochlorite solution at different concentrations and for different exposure times. A log reduction over 6 logs of virus titer is obtained in 1 min with 1.2% sodium hypochlorite when the application is direct; while at a radial distance of 5 cm from the point of application the disinfection reaches a reduction of 5.5 logs in 8 min. In the same way, a higher dilution of the sodium hypochlorite concentration (0.7% NaOCl) requires more exposure time (16 min) to obtain the same log reduction (> 6 logs). COUNTERFOG® creates, in a short time and at a distance of 2 m from the point of application, a thin layer of disinfectant that covers the surfaces. The selection of the concentration and exposure time is critical for the efficacy of disinfection. These tests demonstrate that a concentration between 0.7- 1.2% sodium hypochlorite is enough for a fast and efficient ɸ29 phage inactivation. The fact that ɸ29 phage is more resistant to disinfection than SARS-CoV-2 sustains this disinfection procedure.
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Affiliation(s)
- Cristina Del Álamo
- Escuela Politécnica Superior UAH, Universidad de Alcalá, Campus Universitario, Ctra. Madrid-Barcelona km 33,600, 28805, Alcalá de Henares, Spain.
| | - Ángela Vázquez-Calvo
- Centro de Biología Molecular Severo Ochoa (CBMSO), Consejo Superior de Investigaciones Científicas (CSIC) and Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Antonio Alcamí
- Centro de Biología Molecular Severo Ochoa (CBMSO), Consejo Superior de Investigaciones Científicas (CSIC) and Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | - José Luis Pérez-Díaz
- Escuela Politécnica Superior UAH, Universidad de Alcalá, Campus Universitario, Ctra. Madrid-Barcelona km 33,600, 28805, Alcalá de Henares, Spain
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108
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Abstract
Article Title and Bibliographic Information Meethil AP, Saraswat S, Chaudhary PP, Dabdoub SM, Kumar PS. Sources of SARS-CoV-2 and other microorganisms in dental aerosols. J Dent Res 2021;100(8);817–23. doi: 10.1177/00,220,345,211,015,948. Source of Funding The authors reported that no external funding sources directly supported this study. Type of Study/Design Experimental research.
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109
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Santarpia JL, Herrera VL, Rivera DN, Ratnesar-Shumate S, Reid SP, Ackerman DN, Denton PW, Martens JWS, Fang Y, Conoan N, Callahan MV, Lawler JV, Brett-Major DM, Lowe JJ. The size and culturability of patient-generated SARS-CoV-2 aerosol. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:706-711. [PMID: 34408261 PMCID: PMC8372686 DOI: 10.1038/s41370-021-00376-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Aerosol transmission of COVID-19 is the subject of ongoing policy debate. Characterizing aerosol produced by people with COVID-19 is critical to understanding the role of aerosols in transmission. OBJECTIVE We investigated the presence of virus in size-fractioned aerosols from six COVID-19 patients admitted into mixed acuity wards in April of 2020. METHODS Size-fractionated aerosol samples and aerosol size distributions were collected from COVID-19 positive patients. Aerosol samples were analyzed for viral RNA, positive samples were cultured in Vero E6 cells. Serial RT-PCR of cells indicated samples where viral replication was likely occurring. Viral presence was also investigated by western blot and transmission electron microscopy (TEM). RESULTS SARS-CoV-2 RNA was detected by rRT-PCR in all samples. Three samples confidently indicated the presence of viral replication, all of which were from collected sub-micron aerosol. Western blot indicated the presence of viral proteins in all but one of these samples, and intact virions were observed by TEM in one sample. SIGNIFICANCE Observations of viral replication in the culture of submicron aerosol samples provides additional evidence that airborne transmission of COVID-19 is possible. These results support the use of efficient respiratory protection in both healthcare and by the public to limit transmission.
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Affiliation(s)
- Joshua L Santarpia
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA.
- National Strategic Research Institute, Omaha, NE, USA.
| | - Vicki L Herrera
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Shanna Ratnesar-Shumate
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA
| | - St Patrick Reid
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Paul W Denton
- Department of Biology, University of Nebraska Omaha, Omaha, NE, USA
| | | | - Ying Fang
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nicholas Conoan
- Electron Microscopy Core Facility, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael V Callahan
- Vaccine & Immunotherapy Center, Massachusetts General Hospital, Boston, MA, USA
| | - James V Lawler
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - David M Brett-Major
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - John J Lowe
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE, USA
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110
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Ahmed T, Rawat MS, Ferro AR, Mofakham AA, Helenbrook BT, Ahmadi G, Senarathna D, Mondal S, Brown D, Erath BD. Characterizing respiratory aerosol emissions during sustained phonation. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:689-696. [PMID: 35351959 PMCID: PMC8963400 DOI: 10.1038/s41370-022-00430-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To elucidate the role of phonation frequency (i.e., pitch) and intensity of speech on respiratory aerosol emissions during sustained phonations. METHODS Respiratory aerosol emissions are measured in 40 (24 males and 16 females) healthy, non-trained singers phonating the phoneme /a/ at seven specific frequencies at varying vocal intensity levels. RESULTS Increasing frequency of phonation was positively correlated with particle production (r = 0.28, p < 0.001). Particle production rate was also positively correlated (r = 0.37, p < 0.001) with the vocal intensity of phonation, confirming previously reported findings. The primary mode (particle diameter ~0.6 μm) and width of the particle number size distribution were independent of frequency and vocal intensity. Regression models of the particle production rate using frequency, vocal intensity, and the individual subject as predictor variables only produced goodness of fit of adjusted R2 = 40% (p < 0.001). Finally, it is proposed that superemitters be defined as statistical outliers, which resulted in the identification of one superemitter in the sample of 40 participants. SIGNIFICANCE The results suggest there remain unexplored effects (e.g., biomechanical, environmental, behavioral, etc.) that contribute to the high variability in respiratory particle production rates, which ranged from 0.2 particles/s to 142 particles/s across all trials. This is evidenced as well by changes in the distribution of participant particle production that transitions to a more bimodal distribution (second mode at particle diameter ~2 μm) at higher frequencies and vocal intensity levels.
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Affiliation(s)
- Tanvir Ahmed
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, NY, 13699, USA
| | - Mahender Singh Rawat
- Department of Civil and Environmental Engineering, Clarkson University, Potsdam, NY, 13699, USA
| | - Andrea R Ferro
- Department of Civil and Environmental Engineering, Clarkson University, Potsdam, NY, 13699, USA
| | - Amir A Mofakham
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, NY, 13699, USA
| | - Brian T Helenbrook
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, NY, 13699, USA
| | - Goodarz Ahmadi
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, NY, 13699, USA
| | | | - Sumona Mondal
- Department of Mathematics, Clarkson University, Potsdam, NY, 13699, USA
| | - Deborah Brown
- Joint Educational Programs, Trudeau Institute, Saranac Lake, NY, 12983, USA
| | - Byron D Erath
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, NY, 13699, USA.
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111
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Al Huraimel K, Alhosani M, Gopalani H, Kunhabdulla S, Stietiya MH. Elucidating the role of environmental management of forests, air quality, solid waste and wastewater on the dissemination of SARS-CoV-2. HYGIENE AND ENVIRONMENTAL HEALTH ADVANCES 2022; 3:100006. [PMID: 37519421 PMCID: PMC9095661 DOI: 10.1016/j.heha.2022.100006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/13/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022]
Abstract
The increasing frequency of zoonotic diseases is amongst several catastrophic repercussions of inadequate environmental management. Emergence, prevalence, and lethality of zoonotic diseases is intrinsically linked to environmental management which are currently at a destructive level globally. The effects of these links are complicated and interdependent, creating an urgent need of elucidating the role of environmental mismanagement to improve our resilience to future pandemics. This review focused on the pertinent role of forests, outdoor air, indoor air, solid waste and wastewater management in COVID-19 dissemination to analyze the opportunities prevailing to control infectious diseases considering relevant data from previous disease outbreaks. Global forest management is currently detrimental and hotspots of forest fragmentation have demonstrated to result in zoonotic disease emergences. Deforestation is reported to increase susceptibility to COVID-19 due to wildfire induced pollution and loss of forest ecosystem services. Detection of SARS-CoV-2 like viruses in multiple animal species also point to the impacts of biodiversity loss and forest fragmentation in relation to COVID-19. Available literature on air quality and COVID-19 have provided insights into the potential of air pollutants acting as plausible virus carrier and aggravating immune responses and expression of ACE2 receptors. SARS-CoV-2 is detected in outdoor air, indoor air, solid waste, wastewater and shown to prevail on solid surfaces and aerosols for prolonged hours. Furthermore, lack of protection measures and safe disposal options in waste management are evoking concerns especially in underdeveloped countries due to high infectivity of SARS-CoV-2. Inadequate legal framework and non-adherence to environmental regulations were observed to aggravate the postulated risks and vulnerability to future waves of pandemics. Our understanding underlines the urgent need to reinforce the fragile status of global environmental management systems through the development of strict legislative frameworks and enforcement by providing institutional, financial and technical supports.
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Affiliation(s)
- Khaled Al Huraimel
- Division of Consultancy, Research & Innovation (CRI), Sharjah Environment Company - Bee'ah, Sharjah, United Arab Emirates
| | - Mohamed Alhosani
- Division of Consultancy, Research & Innovation (CRI), Sharjah Environment Company - Bee'ah, Sharjah, United Arab Emirates
| | - Hetasha Gopalani
- Division of Consultancy, Research & Innovation (CRI), Sharjah Environment Company - Bee'ah, Sharjah, United Arab Emirates
| | - Shabana Kunhabdulla
- Division of Consultancy, Research & Innovation (CRI), Sharjah Environment Company - Bee'ah, Sharjah, United Arab Emirates
| | - Mohammed Hashem Stietiya
- Division of Consultancy, Research & Innovation (CRI), Sharjah Environment Company - Bee'ah, Sharjah, United Arab Emirates
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112
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Kurth A, Weber U, Reichenbacher D. Maintaining differential pressure gradients does not increase safety inside modern BSL-4 laboratories. Front Bioeng Biotechnol 2022; 10:953675. [PMID: 36110311 PMCID: PMC9468669 DOI: 10.3389/fbioe.2022.953675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
This article discusses a previously unrecognized contradiction in the design of biosafety level-4 (BSL-4) suit laboratories, also known as maximum or high containment laboratories. For decades, it is suggested that both directional airflow and pressure differentials are essential safety measures to prevent the release of pathogens into the environment and to avoid cross-contamination between laboratory rooms. Despite the absence of an existing evidence-based risk analyses demonstrating increased safety by directional airflow and pressure differentials in BSL-4 laboratories, they were anchored in various national regulations. Currently, the construction and operation of BSL-4 laboratories are subject to rigorous quality and technical requirements including airtight containment. Over time, BSL-4 laboratories evolved to enormously complex technical infrastructures. With the aim to counterbalance this development towards technical simplification while still maintaining maximum safety, we provide a detailed risk analysis by calculating pathogen mitigation in maximum contamination scenarios. The results presented and discussed herein, indicate that both directional airflow or a differential pressure gradient in airtight rooms within a secondary BSL-4 containment do not increase biosafety, and are not necessary. Likewise, reduction of pressure zones from the outside into the secondary containment may also provide sufficient environmental protection. We encourage laboratory design professionals to consider technical simplification and policymakers to adapt corresponding legislation and regulations surrounding directional airflow and pressure differentials for technically airtight BSL-4 laboratories.
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Affiliation(s)
- Andreas Kurth
- Biosafety Level-4 Laboratory, Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Berlin, Germany
- *Correspondence: Andreas Kurth,
| | - Udo Weber
- Ingenieurbüro Udo Weber, Köln, Germany
| | - Detlef Reichenbacher
- Construction, Physical Plant and Technology, Robert Koch Institute, Central Services, Berlin, Germany
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113
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Lohse ZM, Shapiro JJ, Lednicky JA, Cash MN, Jun I, Mavian CN, Tagliamonte MS, Saleem C, Yang Y, Nelson EJ, Salemi M, Ryan KA, Morris JG. Persistence of Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant in Children and Utility of Rapid Antigen Testing as an Indicator of Culturable Virus. Clin Infect Dis 2022; 76:e491-e494. [PMID: 36029095 PMCID: PMC9907546 DOI: 10.1093/cid/ciac693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/09/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
We screened 65 longitudinally collected nasal swab samples from 31 children aged 0-16 years who were positive for severe acute respiratory syndrome coronavirus 2 Omicron BA.1. By day 7 after onset of symptoms, 48% of children remained positive by rapid antigen test. In a sample subset, we found 100% correlation between antigen test results and virus culture.
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Affiliation(s)
- Zoe M Lohse
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA,Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Jerne J Shapiro
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA,Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - John A Lednicky
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA,Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Melanie N Cash
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA,Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Inyoung Jun
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA,Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Carla N Mavian
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA,Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Massimiliano S Tagliamonte
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA,Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Cyrus Saleem
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Yang Yang
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA,Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Eric J Nelson
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA,Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Marco Salemi
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA,Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Kathleen A Ryan
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - J Glenn Morris
- Correspondence: J. G. Morris, Emerging Pathogens Institute, University of Florida, 2055 Mowry Rd., Gainesville, FL, 32610-0009 ()
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114
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Thuresson S, Fraenkel CJ, Sasinovich S, Soldemyr J, Widell A, Medstrand P, Alsved M, Löndahl J. Airborne Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Hospitals: Effects of Aerosol-Generating Procedures, HEPA-Filtration Units, Patient Viral Load, and Physical Distance. Clin Infect Dis 2022; 75:e89-e96. [PMID: 35226740 PMCID: PMC9383519 DOI: 10.1093/cid/ciac161] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Transmission of coronavirus disease 2019 (COVID-19) can occur through inhalation of fine droplets or aerosols containing infectious virus. The objective of this study was to identify situations, patient characteristics, environmental parameters, and aerosol-generating procedures (AGPs) associated with airborne severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. METHODS Air samples were collected near hospitalized COVID-19 patients and analyzed by RT-qPCR. Results were related to distance to the patient, most recent patient diagnostic PCR cycle threshold (Ct) value, room ventilation, and ongoing potential AGPs. RESULTS In total, 310 air samples were collected; of these, 26 (8%) were positive for SARS-CoV-2. Of the 231 samples from patient rooms, 22 (10%) were positive for SARS-CoV-2. Positive air samples were associated with a low patient Ct value (OR, 5.0 for Ct <25 vs >25; P = .01; 95% CI: 1.18-29.5) and a shorter physical distance to the patient (OR, 2.0 for every meter closer to the patient; P = .05; 95% CI: 1.0-3.8). A mobile HEPA-filtration unit in the room decreased the proportion of positive samples (OR, .3; P = .02; 95% CI: .12-.98). No association was observed between SARS-CoV-2-positive air samples and mechanical ventilation, high-flow nasal cannula, nebulizer treatment, or noninvasive ventilation. An association was found with positive expiratory pressure training (P < .01) and a trend towards an association for airway manipulation, including bronchoscopies and in- and extubations. CONCLUSIONS Our results show that major risk factors for airborne SARS-CoV-2 include short physical distance, high patient viral load, and poor room ventilation. AGPs, as traditionally defined, seem to be of secondary importance.
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Affiliation(s)
- Sara Thuresson
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden
| | - Carl Johan Fraenkel
- Department of Infection Control, Region Skåne, Lund, Sweden
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Swedenand
| | | | - Jonathan Soldemyr
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden
| | - Anders Widell
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Patrik Medstrand
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Malin Alsved
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden
| | - Jakob Löndahl
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden
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115
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Adenaiye OO, Lai J, Bueno de Mesquita PJ, Hong F, Youssefi S, German J, Tai SHS, Albert B, Schanz M, Weston S, Hang J, Fung C, Chung HK, Coleman KK, Sapoval N, Treangen T, Berry IM, Mullins K, Frieman M, Ma T, Milton DK. Infectious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Exhaled Aerosols and Efficacy of Masks During Early Mild Infection. Clin Infect Dis 2022; 75:e241-e248. [PMID: 34519774 PMCID: PMC8522431 DOI: 10.1093/cid/ciab797] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemiology implicates airborne transmission; aerosol infectiousness and impacts of masks and variants on aerosol shedding are not well understood. METHODS We recruited coronavirus disease 2019 (COVID-19) cases to give blood, saliva, mid-turbinate and fomite (phone) swabs, and 30-minute breath samples while vocalizing into a Gesundheit-II, with and without masks at up to 2 visits 2 days apart. We quantified and sequenced viral RNA, cultured virus, and assayed serum samples for anti-spike and anti-receptor binding domain antibodies. RESULTS We enrolled 49 seronegative cases (mean days post onset 3.8 ± 2.1), May 2020 through April 2021. We detected SARS-CoV-2 RNA in 36% of fine (≤5 µm), 26% of coarse (>5 µm) aerosols, and 52% of fomite samples overall and in all samples from 4 alpha variant cases. Masks reduced viral RNA by 48% (95% confidence interval [CI], 3 to 72%) in fine and by 77% (95% CI, 51 to 89%) in coarse aerosols; cloth and surgical masks were not significantly different. The alpha variant was associated with a 43-fold (95% CI, 6.6- to 280-fold) increase in fine aerosol viral RNA, compared with earlier viruses, that remained a significant 18-fold (95% CI, 3.4- to 92-fold) increase adjusting for viral RNA in saliva, swabs, and other potential confounders. Two fine aerosol samples, collected while participants wore masks, were culture-positive. CONCLUSIONS SARS-CoV-2 is evolving toward more efficient aerosol generation and loose-fitting masks provide significant but only modest source control. Therefore, until vaccination rates are very high, continued layered controls and tight-fitting masks and respirators will be necessary.
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Affiliation(s)
- Oluwasanmi O Adenaiye
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Jianyu Lai
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - P Jacob Bueno de Mesquita
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Filbert Hong
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Somayeh Youssefi
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Jennifer German
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - S H Sheldon Tai
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Barbara Albert
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Maria Schanz
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Stuart Weston
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jun Hang
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Christian Fung
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Hye Kyung Chung
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Kristen K Coleman
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Nicolae Sapoval
- Department of Computer Science, Rice University, Houston, Texas, USA
| | - Todd Treangen
- Department of Computer Science, Rice University, Houston, Texas, USA
| | - Irina Maljkovic Berry
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Kristin Mullins
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matthew Frieman
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tianzhou Ma
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Donald K Milton
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
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116
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Heatherington E, Zhao X, Goyal N, Ounaies Z, Frecker M. On the Design and Testing of an Origami Inspired Nasal Cover: Mitigating Aerosol Risks During Endoscopic Sinus Procedures. J Med Device 2022. [DOI: 10.1115/1.4055251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Aerosols generated during endoscopic sinus procedures present a concern to the health and safety of healthcare personnel especially with the presence of COVID-19. The purpose of this study is to describe the design and testing of a nasal cover to restrict aerosolized pathogens. The nasal cover was designed to sit overtop the nose with conformal slits for insertion of endoscopic instrumentation. Polydimethylsiloxane (PDMS) was chosen as the nasal mask material and its composition, thickness, and slit geometry were selected using a Taguchi experimental design and survey with clinical collaborators at Penn State Milton S. Hershey Medical Center. The nasal cover was designed using principles of origami engineering to be manufactured flat then folded into its operating state. Form and functionality were evaluated by surgeons, fellows, and residents in the aforementioned survey. Aerosol containment was evaluated by measuring smoke, representative of surgical aerosols, with an optical particle counter. A 25:1 composition PDMS with 3mm thickness and vertical slit geometry was chosen for the nasal cover design. Survey results demonstrated that the origami cover sat well on the nose and did not significantly impact the surgical conditions with single instrumentation. On average, this nasal cover was found to restrict more than 93% of 0.3µm aerosols, and more than 99% of all aerosols larger than 0.5µm in size. Use of a patient worn nasal cover has the potential to drastically reduce the risk to hospital personnel during endonasal surgeries by reducing aerosol generation and potential pathogen spread.
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Affiliation(s)
- Evan Heatherington
- Department of Mechanical Engineering, The Pennsylvania State University, University Park , PA, USA
| | - Xiaoyue Zhao
- Department of Mechanical Engineering, The Pennsylvania State University, University Park , PA, USA
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine , 500 University Dr, MC, Hershey, PA 17033, USA
| | - Zoubeida Ounaies
- Department of Mechanical Engineering, The Pennsylvania State University, University Park , PA, USA
| | - Mary Frecker
- Department of Mechanical Engineering, The Pennsylvania State University, University Park , PA, USA
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117
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Huang W, Wang K, Hung CT, Chow KM, Tsang D, Lai RWM, Xu RH, Yeoh EK, Ho KF, Chen C. Evaluation of SARS-CoV-2 transmission in COVID-19 isolation wards: On-site sampling and numerical analysis. JOURNAL OF HAZARDOUS MATERIALS 2022; 436:129152. [PMID: 35739698 PMCID: PMC9106403 DOI: 10.1016/j.jhazmat.2022.129152] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 05/29/2023]
Abstract
Although airborne transmission has been considered as a possible route for the spread of SARS-CoV-2, the role that aerosols play in SARS-CoV-2 transmission is still controversial. This study evaluated the airborne transmission of SARS-CoV-2 in COVID-19 isolation wards at Prince of Wales Hospital in Hong Kong by both on-site sampling and numerical analysis. A total of 838 air samples and 1176 surface samples were collected, and SARS-CoV-2 RNA was detected using the RT-PCR method. Testing revealed that 2.3% of the air samples and 9.3% of the surface samples were positive, indicating that the isolation wards were contaminated with the virus. The dispersion and deposition of exhaled particles in the wards were calculated by computational fluid dynamics (CFD) simulations. The calculated accumulated number of particles collected at the air sampling points was closely correlated with the SARS-CoV-2 positive rates from the field sampling, which confirmed the possibility of airborne transmission. Furthermore, three potential intervention strategies, i.e., the use of curtains, ceiling-mounted air cleaners, and periodic ventilation, were numerically investigated to explore effective control measures in isolation wards. According to the results, the use of ceiling-mounted air cleaners is effective in reducing the airborne transmission of SARS-CoV-2 in such wards.
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Affiliation(s)
- Wenjie Huang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China
| | - Kailu Wang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China; Centre for Health Systems and Policy Research, JCSPHPC, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China
| | - Chi-Tim Hung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China; Centre for Health Systems and Policy Research, JCSPHPC, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China
| | - Kai-Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T. 999077, Hong Kong, China
| | - Dominic Tsang
- Public Health Laboratory Centre, Centre for Health Protection, Kowloon 999077, Hong Kong, China
| | - Raymond Wai-Man Lai
- Department of Microbiology, Prince of Wales Hospital, Shatin, N.T. 999077, Hong Kong, China
| | - Richard Huan Xu
- Department of Rehabilitation Science, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Kowloon 999077, Hong Kong, China
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China; Centre for Health Systems and Policy Research, JCSPHPC, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China
| | - Kin-Fai Ho
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China.
| | - Chun Chen
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518057, China.
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Ramuta MD, Newman CM, Brakefield SF, Stauss MR, Wiseman RW, Kita-Yarbro A, O'Connor EJ, Dahal N, Lim A, Poulsen KP, Safdar N, Marx JA, Accola MA, Rehrauer WM, Zimmer JA, Khubbar M, Beversdorf LJ, Boehm EC, Castañeda D, Rushford C, Gregory DA, Yao JD, Bhattacharyya S, Johnson MC, Aliota MT, Friedrich TC, O'Connor DH, O'Connor SL. SARS-CoV-2 and other respiratory pathogens are detected in continuous air samples from congregate settings. Nat Commun 2022; 13:4717. [PMID: 35953484 PMCID: PMC9366802 DOI: 10.1038/s41467-022-32406-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/26/2022] [Indexed: 11/09/2022] Open
Abstract
Two years after the emergence of SARS-CoV-2, there is still a need for better ways to assess the risk of transmission in congregate spaces. We deployed active air samplers to monitor the presence of SARS-CoV-2 in real-world settings across communities in the Upper Midwestern states of Wisconsin and Minnesota. Over 29 weeks, we collected 527 air samples from 15 congregate settings. We detected 106 samples that were positive for SARS-CoV-2 viral RNA, demonstrating that SARS-CoV-2 can be detected in continuous air samples collected from a variety of real-world settings. We expanded the utility of air surveillance to test for 40 other respiratory pathogens. Surveillance data revealed differences in timing and location of SARS-CoV-2 and influenza A virus detection. In addition, we obtained SARS-CoV-2 genome sequences from air samples to identify variant lineages. Collectively, this shows air sampling is a scalable, high throughput surveillance tool that could be used in conjunction with other methods for detecting respiratory pathogens in congregate settings.
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Affiliation(s)
- Mitchell D Ramuta
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Christina M Newman
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Savannah F Brakefield
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Roger W Wiseman
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, Madison, WI, USA
| | | | | | - Neeti Dahal
- Wisconsin Veterinary Diagnostic Laboratory, Madison, WI, USA
| | - Ailam Lim
- Wisconsin Veterinary Diagnostic Laboratory, Madison, WI, USA
| | - Keith P Poulsen
- Wisconsin Veterinary Diagnostic Laboratory, Madison, WI, USA
| | - Nasia Safdar
- University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - John A Marx
- University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Molly A Accola
- University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - William M Rehrauer
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Julia A Zimmer
- City of Milwaukee Health Department Laboratory, Milwaukee, WI, USA
| | - Manjeet Khubbar
- City of Milwaukee Health Department Laboratory, Milwaukee, WI, USA
| | | | - Emma C Boehm
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - David Castañeda
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - Clayton Rushford
- Department of Molecular Microbiology and Immunology, University of Missouri, School of Medicine, Columbia, MO, USA
| | - Devon A Gregory
- Department of Molecular Microbiology and Immunology, University of Missouri, School of Medicine, Columbia, MO, USA
| | - Joseph D Yao
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Marc C Johnson
- Department of Molecular Microbiology and Immunology, University of Missouri, School of Medicine, Columbia, MO, USA
| | - Matthew T Aliota
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - Thomas C Friedrich
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - David H O'Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Shelby L O'Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA.
- Wisconsin National Primate Research Center, Madison, WI, USA.
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Subat YW, Meyer TJ, Torgerud KD, Lim KG, Scanlon PD, Niven AS. Use of a Viral Filter to Reduce Exposure to Exhaled Aerosol Does Not Affect Methacholine Dose Delivery During Bronchoprovocation Testing. Respir Care 2022; 67:899-905. [PMID: 35610032 PMCID: PMC9994149 DOI: 10.4187/respcare.09703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Methacholine challenge testing (MCT) is a common bronchoprovocation technique used to assess airway hyper-responsiveness. We previously demonstrated that the addition of a viral filter to the nebulizer exhalation limb substantially reduced expelled particles during MCT. Our aim was to evaluate whether this modification affects the delivered dose of methacholine. METHODS A mechanical ventilator was connected to a lung simulator with breathing frequency 15 breaths/min, tidal volume 500 mL, inspiratory-expiratory ratio 1:1, with a sinusoidal waveform. We compared methacholine dose delivery using the Hudson Micro Mist or AeroEclipse II BAN nebulizers powered by either a dry gas source or a compressor system. A filter placed in line between the nebulizer and test lung was weighed before and after 1 min of nebulized methacholine delivery. Mean inhaled mass was measured with and without a viral filter on the exhalation limb. Dose delivery was calculated by multiplying the mean inhaled mass by the respirable fraction (particles < 5 μm) and inhalation time. Unpaired t test was used to compare methacholine dose delivery with and without viral filter placement. RESULTS The addition of a viral filter did not significantly affect methacholine dose delivery across all devices tested. Using a 50-psi dry gas source, dose delivered with or without a viral filter did not differ with the Hudson (422.3 μg vs 282.0 μg, P = .11) or the AeroEclipse nebulizer (563.0 μg vs 657.6 μg, P = .59). Using the compressor, dose delivered with and without a viral filter did not differ with the Hudson (974.0 μg vs 868.0 μg, P = .03) or the AeroEclipse nebulizer (818.0 μg vs 628.5 μg, P = .42). CONCLUSIONS The addition of a viral filter to the nebulizer exhalation limb did not affect methacholine dose during bronchoprovocation testing. Routine use of a viral filter should be considered to improve pulmonary function technician safety and infection control measures during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Yosuf W Subat
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Todd J Meyer
- Respiratory Care, Mayo Clinic, Rochester, Minnesota
| | - Keith D Torgerud
- Respiratory Care and Cardiopulmonary Diagnostics, Mayo Clinic, La Crosse, Wisconsin
| | - Kaiser G Lim
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul D Scanlon
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alexander S Niven
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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Molecular detection of SARS-COV-2 in exhaled breath at the point-of-need. Biosens Bioelectron 2022; 217:114663. [PMID: 36150327 PMCID: PMC9424122 DOI: 10.1016/j.bios.2022.114663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 12/19/2022]
Abstract
The SARS-CoV-2 pandemic has highlighted the need for improved technologies to help control the spread of contagious pathogens. While rapid point-of-need testing plays a key role in strategies to rapidly identify and isolate infectious patients, current test approaches have significant shortcomings related to assay limitations and sample type. Direct quantification of viral shedding in exhaled particles may offer a better rapid testing approach, since SARS-CoV-2 is believed to spread mainly by aerosols. It assesses contagiousness directly, the sample is easy and comfortable to obtain, sampling can be standardized, and the limited sample volume lends itself to a fast and sensitive analysis. In view of these benefits, we developed and tested an approach where exhaled particles are efficiently sampled using inertial impaction in a micromachined silicon chip, followed by an RT-qPCR molecular assay to detect SARS-CoV-2 shedding. Our portable, silicon impactor allowed for the efficient capture (>85%) of respiratory particles down to 300 nm without the need for additional equipment. We demonstrate using both conventional off-chip and in-situ PCR directly on the silicon chip that sampling subjects’ breath in less than a minute yields sufficient viral RNA to detect infections as early as standard sampling methods. A longitudinal study revealed clear differences in the temporal dynamics of viral load for nasopharyngeal swab, saliva, breath, and antigen tests. Overall, after an infection, the breath-based test remains positive during the first week but is the first to consistently report a negative result, putatively signalling the end of contagiousness and further emphasizing the potential of this tool to help manage the spread of airborne respiratory infections.
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Hare D, Meaney C, Powell J, Slevin B, O' Brien B, Power L, O' Connell N, De Gascun C, Dunne C, Stapleton P. Repeated transmission of SARS-CoV-2 in an overcrowded Irish emergency department elucidated by whole-genome sequencing. J Hosp Infect 2022; 126:1-9. [PMID: 35562074 PMCID: PMC9088210 DOI: 10.1016/j.jhin.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 01/11/2023]
Abstract
AIM To provide a detailed genomic-epidemiological description of a complex multi-ward SARS-CoV-2 outbreak, which originated in the crowded emergency department (ED) in our hospital during the third wave of the COVID-19 pandemic, and was elucidated promptly by local whole-genome sequencing (WGS). METHODS SARS-CoV-2 was detected by reverse transcriptase real-time polymerase chain reaction on viral RNA extracted from nasopharyngeal swabs. WGS was performed using an Oxford MinION Mk1C instrument following the ARTIC v3 sequencing protocol. High-quality consensus genomes were assembled with the artic-ncov2019 bioinformatics pipeline and viral phylogenetic trees were built, inferred by maximum-likelihood. Clusters were defined using a threshold of 0-1 single nucleotide polymorphisms (SNPs) between epidemiologically linked sequences. RESULTS In April 2021, outbreaks of COVID-19 were declared on two wards at University Hospital Limerick after 4 healthcare-associated SARS-CoV-2 infections were detected by post-admission surveillance testing. Contact tracing identified 12 further connected cases; all with direct or indirect links to the ED 'COVID Zone'. All sequences were assigned to the Pangolin B.1.1.7 lineage by WGS, and SNP-level analysis revealed two distinct but simultaneous clusters of infections. Repeated transmission in the ED was demonstrated, involving patients accommodated on trolleys in crowded areas, resulting in multiple generations of infections across three inpatient hospital wards and subsequently to the local community. These findings informed mitigation efforts to prevent cross-transmission in the ED. CONCLUSION Cross-transmission of SARS-CoV-2 occurred repeatedly in an overcrowded emergency department. Viral WGS elucidated complex viral transmission networks in our hospital and informed infection, prevention and control practice.
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Affiliation(s)
- D. Hare
- Department of Clinical Microbiology, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland,School of Medicine, University of Limerick, Limerick, Ireland,UCD National Virus Reference Laboratory, University College Dublin, Dublin, Ireland,Corresponding author. Address: Department of Clinical Microbiology University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland
| | - C. Meaney
- Department of Clinical Microbiology, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland
| | - J. Powell
- Department of Clinical Microbiology, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland,Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - B. Slevin
- Department of Infection, Prevention and Control, University Hospital Limerick, Limerick, Ireland
| | - B. O' Brien
- Department of Infection, Prevention and Control, University Hospital Limerick, Limerick, Ireland
| | - L. Power
- Department of Clinical Microbiology, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland
| | - N.H. O' Connell
- Department of Clinical Microbiology, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland,School of Medicine, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - C.F. De Gascun
- UCD National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - C.P. Dunne
- School of Medicine, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - P.J. Stapleton
- Department of Clinical Microbiology, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Ireland,School of Medicine, University of Limerick, Limerick, Ireland
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Yan K, Lin J, Albaugh S, Yang M, Wang E, Cyberski T, Abasiyanik MF, Wroblewski KE, O'Connor M, Klock A, Tung A, Shahul S, Kurian D, Tay S, Pinto JM. Measuring SARS-CoV-2 aerosolization in rooms of hospitalized patients. Laryngoscope Investig Otolaryngol 2022; 7:1033-1041. [PMID: 35942422 PMCID: PMC9350181 DOI: 10.1002/lio2.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/12/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Airborne spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a significant risk for healthcare workers. Understanding transmission of SARS-CoV-2 in the hospital could help minimize nosocomial infection. The objective of this pilot study was to measure aerosolization of SARS-CoV-2 in the hospital rooms of COVID-19 patients. Methods Two air samplers (Inspirotec) were placed 1 and 4 m away from adults with SARS-CoV-2 infection hospitalized at an urban, academic tertiary care center from June to October 2020. Airborne SARS-CoV-2 concentration was measured by quantitative reverse transcription polymerase chain reaction and analyzed by clinical parameters and patient demographics. Results Thirteen patients with COVID-19 (eight females [61.5%], median age: 57 years old, range 25-82) presented with shortness of breath (100%), cough (38.5%) and fever (15.4%). Respiratory therapy during air sampling varied: mechanical ventilation via endotracheal tube (n = 3), high flow nasal cannula (n = 4), nasal cannula (n = 4), respiratory helmet (n = 1), and room air (n = 1). SARS-CoV-2 RNA was identified in rooms of three out of three intubated patients compared with one out of 10 of the non-intubated patients (p = .014). Airborne SARS-CoV-2 tended to decrease with distance (1 vs. 4 m) in rooms of intubated patients. Conclusions Hospital rooms of intubated patients had higher levels of aerosolized SARS-CoV-2, consistent with increased aerosolization of virus in patients with severe disease or treatment with positive pressure ventilation through an endotracheal tube. While preliminary, these data have safety implications for health care workers and design of protective measures in the hospital. Level of Evidence 2.
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Affiliation(s)
- Kenneth Yan
- Department of Head and Neck SurgeryUniversity of California Los AngelesCaliforniaLos AngelesUSA
| | - Jing Lin
- Pritzker School of Molecular EngineeringThe University of ChicagoChicagoIllinoisUSA
- Institute for Genomics and Systems BiologyThe University of ChicagoChicagoIllinoisUSA
| | - Shaley Albaugh
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Meredith Yang
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Esther Wang
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Thomas Cyberski
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Mustafa Fatih Abasiyanik
- Pritzker School of Molecular EngineeringThe University of ChicagoChicagoIllinoisUSA
- Institute for Genomics and Systems BiologyThe University of ChicagoChicagoIllinoisUSA
| | | | - Michael O'Connor
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Allan Klock
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Avery Tung
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Sajid Shahul
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Dinesh Kurian
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Savaş Tay
- Pritzker School of Molecular EngineeringThe University of ChicagoChicagoIllinoisUSA
- Institute for Genomics and Systems BiologyThe University of ChicagoChicagoIllinoisUSA
| | - Jayant M. Pinto
- Section of Otolaryngology‐Head and Neck Surgery, Department of SurgeryThe University of ChicagoChicagoIllinoisUSA
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123
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Silva PG, Branco PTBS, Soares RRG, Mesquita JR, Sousa SIV. SARS-CoV-2 air sampling: A systematic review on the methodologies for detection and infectivity. INDOOR AIR 2022; 32:e13083. [PMID: 36040285 PMCID: PMC9538005 DOI: 10.1111/ina.13083] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
This systematic review aims to present an overview of the current aerosol sampling methods (and equipment) being used to investigate the presence of SARS-CoV-2 in the air, along with the main parameters reported in the studies that are essential to analyze the advantages and disadvantages of each method and perspectives for future research regarding this mode of transmission. A systematic literature review was performed on PubMed/MEDLINE, Web of Science, and Scopus to assess the current air sampling methodologies being applied to SARS-CoV-2. Most of the studies took place in indoor environments and healthcare settings and included air and environmental sampling. The collection mechanisms used were impinger, cyclone, impactor, filters, water-based condensation, and passive sampling. Most of the reviewed studies used RT-PCR to test the presence of SARS-CoV-2 RNA in the collected samples. SARS-CoV-2 RNA was detected with all collection mechanisms. From the studies detecting the presence of SARS-CoV-2 RNA, fourteen assessed infectivity. Five studies detected viable viruses using impactor, water-based condensation, and cyclone collection mechanisms. There is a need for a standardized protocol for sampling SARS-CoV-2 in air, which should also account for other influencing parameters, including air exchange ratio in the room sampled, relative humidity, temperature, and lighting conditions.
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Affiliation(s)
- Priscilla G Silva
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
- Epidemiology Research Unit (EPI Unit), Institute of Public Health, University of Porto, Porto, Portugal
| | - Pedro T B S Branco
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
| | - Ruben R G Soares
- Department of Biochemistry and Biophysics, Science for Life Laboratory, Stockholm University, Solna, Sweden
- Division of Nanobiotechnology, Department of Protein Science, Science for Life Laboratory, KTH Royal Institute of Technology, Solna, Sweden
| | - João R Mesquita
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Epidemiology Research Unit (EPI Unit), Institute of Public Health, University of Porto, Porto, Portugal
| | - Sofia I V Sousa
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
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Abstract
During the early phase of the COVID-19 pandemic, many respiratory therapies were classified as aerosol-generating procedures. This categorization resulted in a broad range of clinical concerns and a shortage of essential medical resources for some patients. In the past 2 years, many studies have assessed the transmission risk posed by various respiratory care procedures. These studies are discussed in this narrative review, with recommendations for mitigating transmission risk based on the current evidence.
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Affiliation(s)
- Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, Illinois
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125
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Prevention of SARS-CoV-2 and respiratory viral infections in healthcare settings: current and emerging concepts. Curr Opin Infect Dis 2022; 35:353-362. [PMID: 35849526 DOI: 10.1097/qco.0000000000000839] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW COVID-19 has catalyzed a wealth of new data on the science of respiratory pathogen transmission and revealed opportunities to enhance infection prevention practices in healthcare settings. RECENT FINDINGS New data refute the traditional division between droplet vs airborne transmission and clarify the central role of aerosols in spreading all respiratory viruses, including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), even in the absence of so-called 'aerosol-generating procedures' (AGPs). Indeed, most AGPs generate fewer aerosols than talking, labored breathing, or coughing. Risk factors for transmission include high viral loads, symptoms, proximity, prolonged exposure, lack of masking, and poor ventilation. Testing all patients on admission and thereafter can identify early occult infections and prevent hospital-based clusters. Additional prevention strategies include universal masking, encouraging universal vaccination, preferential use of N95 respirators when community rates are high, improving native ventilation, utilizing portable high-efficiency particulate air filters when ventilation is limited, and minimizing room sharing when possible. SUMMARY Multifaceted infection prevention programs that include universal testing, masking, vaccination, and enhanced ventilation can minimize nosocomial SARS-CoV-2 infections in patients and workplace infections in healthcare personnel. Extending these insights to other respiratory viruses may further increase the safety of healthcare and ready hospitals for novel respiratory viruses that may emerge in the future.
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Moharir SC, Thota SC, Goel A, Thakur B, Tandel D, Reddy SM, Vodapalli A, Singh Bhalla G, Kumar D, Singh Naruka D, Kumar A, Tuli A, Suravaram S, Chander Bingi T, Srinivas M, Mesipogu R, Reddy K, Khosla S, Harshan KH, Bharadwaj Tallapaka K, Mishra RK. Detection of SARS-CoV-2 in the air in Indian hospitals and houses of COVID-19 patients. JOURNAL OF AEROSOL SCIENCE 2022; 164:106002. [PMID: 35495416 PMCID: PMC9040488 DOI: 10.1016/j.jaerosci.2022.106002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 05/05/2023]
Abstract
To understand the transmission characteristics of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) through air, samples from different locations occupied by coronavirus disease (COVID-19) patients were analyzed. Three sampling strategies were used to understand the presence of virus in the air in different environmental conditions. In the first strategy, which involved hospital settings, air samples were collected from several areas of hospitals like COVID-intensive-care units (ICUs), nurse-stations, COVID-wards, corridors, non-COVID-wards, personal protective equipment (PPE) doffing areas, COVID rooms, out-patient (OP) corridors, mortuary, COVID casualty areas, non-COVID ICUs and doctors' rooms. Out of the 80 air samples collected from 6 hospitals from two Indian cities- Hyderabad and Mohali, 30 samples showed the presence of SARS-CoV-2 nucleic acids. In the second sampling strategy, that involved indoor settings, one or more COVID-19 patients were asked to spend a short duration of time in a closed room. Out of 17 samples, 5 samples, including 4 samples collected after the departure of three symptomatic patients from the room, showed the presence of SARS-CoV-2 nucleic acids. In the third strategy, involving indoor settings, air samples were collected from rooms of houses of home-quarantined COVID-19 patients and it was observed that SARS-CoV-2 RNA could be detected in the air in the rooms occupied by COVID-19 patients but not in the other rooms of the houses. Taken together, we observed that the air around COVID-19 patients frequently showed the presence of SARS-CoV-2 RNA in both hospital and indoor residential settings and the positivity rate was higher when 2 or more COVID-19 patients occupied the room. In hospitals, SARS-CoV-2 RNA could be detected in ICUs as well as in non-ICUs, suggesting that the viral shedding happened irrespective of the severity of the infection. This study provides evidence for the viability of SARS-CoV-2 and its long-range transport through the air. Thus, airborne transmission could be a major mode of transmission for SARS-CoV-2 and appropriate precautions need to be followed to prevent the spread of infection through the air.
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Affiliation(s)
- Shivranjani C Moharir
- CSIR- Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, 500007, India
- The Tata Institute for Genetics and Society, Bangalore, 560065, India
| | - Sharath Chandra Thota
- CSIR- Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, 500007, India
| | - Arushi Goel
- CSIR- Institute of Microbial Technology (CSIR-IMTech), Chandigarh, 160036, India
| | - Bhuwaneshwar Thakur
- CSIR- Institute of Microbial Technology (CSIR-IMTech), Chandigarh, 160036, India
| | - Dixit Tandel
- CSIR- Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, 500007, India
| | - S Mahesh Reddy
- CSIR- Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, 500007, India
| | - Amareshwar Vodapalli
- CSIR- Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, 500007, India
| | | | - Dinesh Kumar
- CSIR- Institute of Microbial Technology (CSIR-IMTech), Chandigarh, 160036, India
| | | | - Ashwani Kumar
- CSIR- Institute of Microbial Technology (CSIR-IMTech), Chandigarh, 160036, India
| | - Amit Tuli
- CSIR- Institute of Microbial Technology (CSIR-IMTech), Chandigarh, 160036, India
| | | | | | - M Srinivas
- ESI Hospital and Medical College, Hyderabad, 500018, India
| | | | - Krishna Reddy
- Durgabai Deshmukh Hospital, Hyderabad, 500044, India
| | - Sanjeev Khosla
- CSIR- Institute of Microbial Technology (CSIR-IMTech), Chandigarh, 160036, India
| | - Krishnan H Harshan
- CSIR- Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, 500007, India
| | | | - Rakesh K Mishra
- CSIR- Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, 500007, India
- The Tata Institute for Genetics and Society, Bangalore, 560065, India
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Habibi N, Uddin S, Behbehani M, Al Salameen F, Razzack NA, Zakir F, Shajan A, Alam F. Bacterial and fungal communities in indoor aerosols from two Kuwaiti hospitals. Front Microbiol 2022; 13:955913. [PMID: 35966680 PMCID: PMC9366136 DOI: 10.3389/fmicb.2022.955913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
The airborne transmission of COVID-19 has drawn immense attention to bioaerosols. The topic is highly relevant in the indoor hospital environment where vulnerable patients are treated and healthcare workers are exposed to various pathogenic and non-pathogenic microbes. Knowledge of the microbial communities in such settings will enable precautionary measures to prevent any hospital-mediated outbreak and better assess occupational exposure of the healthcare workers. This study presents a baseline of the bacterial and fungal population of two major hospitals in Kuwait dealing with COVID patients, and in a non-hospital setting through targeted amplicon sequencing. The predominant bacteria of bioaerosols were Variovorax (9.44%), Parvibaculum (8.27%), Pseudonocardia (8.04%), Taonella (5.74%), Arthrospira (4.58%), Comamonas (3.84%), Methylibium (3.13%), Sphingobium (4.46%), Zoogloea (2.20%), and Sphingopyxis (2.56%). ESKAPEE pathogens, such as Pseudomonas, Acinetobacter, Staphylococcus, Enterococcus, and Escherichia, were also found in lower abundances. The fungi were represented by Wilcoxinia rehmii (64.38%), Aspergillus ruber (9.11%), Penicillium desertorum (3.89%), Leptobacillium leptobactrum (3.20%), Humicola grisea (2.99%), Ganoderma sichuanense (1.42%), Malassezia restricta (0.74%), Heterophoma sylvatica (0.49%), Fusarium proliferatum (0.46%), and Saccharomyces cerevisiae (0.23%). Some common and unique operational taxonomic units (OTUs) of bacteria and fungi were also recorded at each site; this inter-site variability shows that exhaled air can be a source of this variation. The alpha-diversity indices suggested variance in species richness and abundance in hospitals than in non-hospital sites. The community structure of bacteria varied spatially (ANOSIM r 2 = 0.181-0.243; p < 0.05) between the hospital and non-hospital sites, whereas fungi were more or less homogenous. Key taxa specific to the hospitals were Defluvicoccales, fungi, Ganodermataceae, Heterophoma, and H. sylvatica compared to Actinobacteria, Leptobacillium, L. leptobacillium, and Cordycipitaceae at the non-hospital site (LefSe, FDR q ≤ 0.05). The hospital/non-hospital MD index > 1 indicated shifts in the microbial communities of indoor air in hospitals. These findings highlight the need for regular surveillance of indoor hospital environments to prevent future outbreaks.
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Affiliation(s)
| | - Saif Uddin
- Environment and Life Science Research Centre, Kuwait Institute for Scientific Research, Kuwait City, Kuwait
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Jang J, Bhardwaj J, Jang J. Efficient measurement of airborne viable viruses using the growth-based virus aerosol concentrator with high flow velocities. JOURNAL OF HAZARDOUS MATERIALS 2022; 434:128873. [PMID: 35427967 DOI: 10.1016/j.jhazmat.2022.128873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/25/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
Growth tube collectors (GTCs) are used to sample virus aerosols because of their superior viable virus recovery among air samplers. However, a major limitation of such samplers is that they operate at low flow rates compared to many inertia-based air samplers. Herein, we demonstrated efficient measurements of airborne MS2 and T3 viruses using a GTC that can implement high flow velocities for higher flow rates per tube, which we refer to as the growth-based virus aerosol concentrator (GVC), via qPCR and the plaque assay technique. The GVC exhibited a flow rate of up to 6 L/min, where the average sampling flow velocity was 5.09 m/s, 22 times higher than those used in the GTCs, for a single tube with a diameter of 5 mm. The count median diameter of the size-increased particles at the exit of the initiator was measured to be 1.44 µm at 6 L/min, considerably smaller than those observed in conventional GTCs. Nevertheless, the measurement of airborne MS2 and T3 viruses using the GVC showed a high concentration (high enrichment ratio of 109,458 at 10-min sampling) of viruses in a sampling medium, with a high viable virus percentage (> 90%) and physical collection efficiency (> 90%) at 6 L/min, which shows the potential for rapid on-site detection of airborne viruses.
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Affiliation(s)
- Junbeom Jang
- Sensors and Aerosols Laboratory, Department of Mechanical Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Republic of Korea
| | - Jyoti Bhardwaj
- Sensors and Aerosols Laboratory, Department of Mechanical Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Republic of Korea
| | - Jaesung Jang
- Sensors and Aerosols Laboratory, Department of Mechanical Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Republic of Korea; Department of Biomedical Engineering & Department of Urban and Environmental Engineering, UNIST, Ulsan 44919, Republic of Korea.
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Lu F, Gecgel O, Ramanujam A, Botte GG. SARS-CoV-2 Surveillance in Indoor Air Using Electrochemical Sensor for Continuous Monitoring and Real-Time Alerts. BIOSENSORS 2022; 12:523. [PMID: 35884326 PMCID: PMC9312472 DOI: 10.3390/bios12070523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
The severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) has spread globally and there is still a lack of rapid detection techniques for SARS-CoV-2 surveillance in indoor air. In this work, two test rigs were developed that enable continuous air monitoring for the detection of SARS-CoV-2 by sample collection and testing. The collected samples from simulated SARS-CoV-2 contaminated air were analyzed using an ultra-fast COVID-19 diagnostic sensor (UFC-19). The test rigs utilized two air sampling methods: cyclone-based collection and internal impaction. The former achieved a limit of detection (LoD) of 0.004 cp/L in the air (which translates to 0.5 cp/mL when tested in aqueous solution), lower than the latter with a limit of 0.029 cp/L in the air. The LoD of 0.5 cp/mL using the UFC-19 sensor in aqueous solution is significantly lower than the best-in-class assays (100 cp/mL) and FDA EUA RT-PCR test (6250 cp/mL). In addition, the developed test rig provides an ultra-fast method to detect airborne SARS-CoV-2. The required time to test 250 L air is less than 5 min. While most of the time is consumed by the air collection process, the sensing is completed in less than 2 s using the UFC-19 sensor. This method is much faster than both the rapid antigen (<20 min) and RT-PCR test (<90 min).
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Herazo MS, Nani G, Zurita F, Nakase C, Zamora S, Herazo LCS, Betanzo-Torres EA. A Review of the Presence of SARS-CoV-2 in Wastewater: Transmission Risks in Mexico. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8354. [PMID: 35886204 PMCID: PMC9324675 DOI: 10.3390/ijerph19148354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/21/2022] [Accepted: 07/05/2022] [Indexed: 12/11/2022]
Abstract
The appearance of SARS-CoV-2 represented a new health threat to humanity and affected millions of people; the transmission of this virus occurs through different routes, and one of them recently under debate in the international community is its possible incorporation and spread by sewage. Therefore, the present work's research objectives are to review the presence of SARS-CoV-2 in wastewater throughout the world and to analyze the coverage of wastewater treatment in Mexico to determine if there is a correlation between the positive cases of COVID-19 and the percentages of treated wastewater in Mexico as well as to investigate the evidence of possible transmission by aerosol sand untreated wastewater. Methodologically, a quick search of scientific literature was performed to identify evidence the presence of SARS-CoV-2 RNA (ribonucleic acid) in wastewater in four international databases. The statistical information of the positive cases of COVID-19 was obtained from data from the Health Secretary of the Mexican Government and the Johns Hopkins Coronavirus Resource Center. The information from the wastewater treatment plants in Mexico was obtained from official information of the National Water Commission of Mexico. The results showed sufficient evidence that SARS-CoV-2 remains alive in municipal wastewater in Mexico. Our analysis indicates that there is a low but significant correlation between the percentage of treated water and positive cases of coronavirus r = -0.385, with IC (95%) = (-0.647, -0.042) and p = 0.030; this result should be taken with caution because wastewater is not a transmission mechanism, but this finding is useful to highlight the need to increase the percentage of treated wastewater and to do it efficiently. In conclusions, the virus is present in untreated wastewater, and the early detection of SAR-CoV-2 could serve as a bioindicator method of the presence of the virus. This could be of great help to establish surveillance measures by zones to take preventive actions, which to date have not been considered by the Mexican health authorities. Unfortunately, wastewater treatment systems in Mexico are very fragile, and coverage is limited to urban areas and non-existent in rural areas. Furthermore, although the probability of contagion is relatively low, it can be a risk for wastewater treatment plant workers and people who are close to them.
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Affiliation(s)
- Mayerlin Sandoval Herazo
- Department of Engineering in Business Management, Tecnológico Nacional de México/Instituto Tecnológico de Misantla, Misantla 93821, Veracruz, Mexico; (M.S.H.); (G.N.)
- Wetland and Environmental Sustainability Laboratory, Division of Postgraduate Studies and Research, Tecnológico Nacional de México/Instituto Tecnológico de Misantla, Misantla 93821, Veracruz, Mexico
| | - Graciela Nani
- Department of Engineering in Business Management, Tecnológico Nacional de México/Instituto Tecnológico de Misantla, Misantla 93821, Veracruz, Mexico; (M.S.H.); (G.N.)
- Wetland and Environmental Sustainability Laboratory, Division of Postgraduate Studies and Research, Tecnológico Nacional de México/Instituto Tecnológico de Misantla, Misantla 93821, Veracruz, Mexico
| | - Florentina Zurita
- Research Center in Environmental Quality, Centro Universitario de la Ciénega, Universidad de Guadalajara, Av. Universidad 1115, Ocotlán 4782, Jalisco, Mexico;
| | - Carlos Nakase
- Public Works Department, University of Local Government of Martínez de la Torre, Veracruz 93605, Veracruz, Mexico;
| | - Sergio Zamora
- Faculty of Engineering, Construction and Habitation, Universidad Veracruzana, Bv. Adolfo Ruíz Cortines 455, Costa Verde, Boca del Rio 94294, Veracruz, Mexico;
| | - Luis Carlos Sandoval Herazo
- Wetland and Environmental Sustainability Laboratory, Division of Postgraduate Studies and Research, Tecnológico Nacional de México/Instituto Tecnológico de Misantla, Misantla 93821, Veracruz, Mexico
| | - Erick Arturo Betanzo-Torres
- Estancia Postdoctoral CONACYT (Consejo Nacional de Ciencia y Tecnologia) Tecnológico Nacional de México Campus Misantla, Misantla 93821, Veracruz, Mexico
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Aganovic A, Bi Y, Cao G, Kurnitski J, Wargocki P. Modeling the impact of indoor relative humidity on the infection risk of five respiratory airborne viruses. Sci Rep 2022; 12:11481. [PMID: 35798789 PMCID: PMC9261129 DOI: 10.1038/s41598-022-15703-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/28/2022] [Indexed: 11/09/2022] Open
Abstract
With a modified version of the Wells-Riley model, we simulated the size distribution and dynamics of five airborne viruses (measles, influenza, SARS-CoV-2, human rhinovirus, and adenovirus) emitted from a speaking person in a typical residential setting over a relative humidity (RH) range of 20-80% and air temperature of 20-25 °C. Besides the size transformation of virus-containing droplets due to evaporation, respiratory absorption, and then removal by gravitational settling, the modified model also considered the removal mechanism by ventilation. The trend and magnitude of RH impact depended on the respiratory virus. For rhinovirus and adenovirus humidifying the indoor air from 20/30 to 50% will be increasing the relative infection risk, however, this relative infection risk increase will be negligible for rhinovirus and weak for adenovirus. Humidification will have a potential benefit in decreasing the infection risk only for influenza when there is a large infection risk decrease for humidifying from 20 to 50%. Regardless of the dry solution composition, humidification will overall increase the infection risk via long-range airborne transmission of SARS-CoV-2. Compared to humidification at a constant ventilation rate, increasing the ventilation rate to moderate levels 0.5 → 2.0 h-1 will have a more beneficial infection risk decrease for all viruses except for influenza. Increasing the ventilation rate from low values of 0.5 h-1 to higher levels of 6 h-1 will have a dominating effect on reducing the infection risk regardless of virus type.
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Affiliation(s)
- Amar Aganovic
- Department of Automation and Process Engineering, The Arctic University of Norway-UiT, 9019, Tromsø, Norway.
| | - Yang Bi
- Department of Energy and Process Engineering, Norwegian University of Science and Technology-NTNU, 7491, Trondheim, Norway
| | - Guangyu Cao
- Department of Energy and Process Engineering, Norwegian University of Science and Technology-NTNU, 7491, Trondheim, Norway
| | - Jarek Kurnitski
- REHVA Technology and Research Committee, Tallinn University of Technology, 19086, Tallinn, Estonia
| | - Pawel Wargocki
- Department of Civil Engineering, Technical University of Denmark, 2800, Copenhagen, Kgs, Denmark
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Oswin HP, Haddrell AE, Otero-Fernandez M, Mann JFS, Cogan TA, Hilditch TG, Tian J, Hardy DA, Hill DJ, Finn A, Davidson AD, Reid JP. The dynamics of SARS-CoV-2 infectivity with changes in aerosol microenvironment. Proc Natl Acad Sci U S A 2022; 119:e2200109119. [PMID: 35763573 PMCID: PMC9271203 DOI: 10.1073/pnas.2200109119] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Understanding the factors that influence the airborne survival of viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in aerosols is important for identifying routes of transmission and the value of various mitigation strategies for preventing transmission. We present measurements of the stability of SARS-CoV-2 in aerosol droplets (∼5 to 10 µm equilibrated radius) over timescales spanning 5 s to 20 min using an instrument to probe survival in a small population of droplets (typically 5 to 10) containing ∼1 virus/droplet. Measurements of airborne infectivity change are coupled with a detailed physicochemical analysis of the airborne droplets containing the virus. A decrease in infectivity to ∼10% of the starting value was observable for SARS-CoV-2 over 20 min, with a large proportion of the loss occurring within the first 5 min after aerosolization. The initial rate of infectivity loss was found to correlate with physical transformation of the equilibrating droplet; salts within the droplets crystallize at relative humidities (RHs) below 50%, leading to a near-instant loss of infectivity in 50 to 60% of the virus. However, at 90% RH, the droplet remains homogenous and aqueous, and the viral stability is sustained for the first 2 min, beyond which it decays to only 10% remaining infectious after 10 min. The loss of infectivity at high RH is consistent with an elevation in the pH of the droplets, caused by volatilization of CO2 from bicarbonate buffer within the droplet. Four different variants of SARS-CoV-2 were compared and found to have a similar degree of airborne stability at both high and low RH.
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Affiliation(s)
- Henry P. Oswin
- aSchool of Chemistry, Cantock’s Close, University of Bristol, Bristol BS8 1TS, United Kingdom
| | - Allen E. Haddrell
- aSchool of Chemistry, Cantock’s Close, University of Bristol, Bristol BS8 1TS, United Kingdom
- 1To whom correspondence may be addressed. , , or
| | - Mara Otero-Fernandez
- aSchool of Chemistry, Cantock’s Close, University of Bristol, Bristol BS8 1TS, United Kingdom
| | - Jamie F. S. Mann
- bBristol Veterinary School, University of Bristol, Langford, Bristol BS40 5DU, United Kingdom
| | - Tristan A. Cogan
- bBristol Veterinary School, University of Bristol, Langford, Bristol BS40 5DU, United Kingdom
| | - Thomas G. Hilditch
- aSchool of Chemistry, Cantock’s Close, University of Bristol, Bristol BS8 1TS, United Kingdom
| | - Jianghan Tian
- aSchool of Chemistry, Cantock’s Close, University of Bristol, Bristol BS8 1TS, United Kingdom
| | - Daniel A. Hardy
- aSchool of Chemistry, Cantock’s Close, University of Bristol, Bristol BS8 1TS, United Kingdom
| | - Darryl J. Hill
- cSchool of Cellular and Molecular Medicine, University of Bristol, Bristol BS8 1TS, United Kingdom
| | - Adam Finn
- cSchool of Cellular and Molecular Medicine, University of Bristol, Bristol BS8 1TS, United Kingdom
| | - Andrew D. Davidson
- cSchool of Cellular and Molecular Medicine, University of Bristol, Bristol BS8 1TS, United Kingdom
- 1To whom correspondence may be addressed. , , or
| | - Jonathan P. Reid
- aSchool of Chemistry, Cantock’s Close, University of Bristol, Bristol BS8 1TS, United Kingdom
- 1To whom correspondence may be addressed. , , or
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Chen H, Ma X, Zhang X, Hu G, Deng Y, Li S, Chen Z, He N, Wu Y, Jiang Z. Novel aerosol detection platform for SARS‑CoV‑2: Based on specific magnetic nanoparticles adsorption sampling and digital droplet PCR detection. CHINESE CHEM LETT 2022; 34:107701. [PMID: 35911611 PMCID: PMC9308147 DOI: 10.1016/j.cclet.2022.07.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 12/16/2022]
Abstract
The SARS‑CoV‑2 virus is released from an infectious source (such as a sick person) and adsorbed on aerosols, which can form pathogenic microorganism aerosols, which can affect human health through airborne transmission. Efficient sampling and accurate detection of microorganisms in aerosols are the premise and basis for studying their properties and evaluating their hazard. In this study, we built a set of sub-micron aerosol detection platform, and carried out a simulation experiment on the SARS‑CoV‑2 aerosol in the air by wet-wall cyclone combined with immunomagnetic nanoparticle adsorption sampling and ddPCR. The feasibility of the system in aerosol detection was verified, and the influencing factors in the detection process were experimentally tested. As a result, the sampling efficiency was 29.77%, and extraction efficiency was 98.57%. The minimum detection limit per unit volume of aerosols was 250 copies (102 copies/mL, concentration factor 2.5).
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Magalis BR, Mavian C, Tagliamonte M, Rich SN, Cash M, Riva A, Loeb JC, Norris M, Amador DM, Zhang Y, Shapiro J, Starostik P, Marini S, Myers P, Ostrov DA, Lednicky JA, Glenn Morris J, Lauzardo M, Salemi M. Low-frequency variants in mildly symptomatic vaccine breakthrough infections presents a doubled-edged sword. J Med Virol 2022; 94:3192-3202. [PMID: 35307848 PMCID: PMC9325371 DOI: 10.1002/jmv.27726] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/24/2022] [Accepted: 03/16/2022] [Indexed: 12/15/2022]
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOC) has raised questions regarding vaccine protection against SARS-CoV-2 infection, transmission, and ongoing virus evolution. Twenty-three mildly symptomatic "vaccination breakthrough" infections were identified as early as January 2021 in Alachua County, Florida, among individuals fully vaccinated with either the BNT162b2 (Pfizer) or the Ad26 (Janssen/J&J) vaccines. SARS-CoV-2 genomes were successfully generated for 11 of the vaccine breakthroughs, and 878 individuals in the surrounding area and were included for reference-based phylogenetic investigation. These 11 individuals were characterized by infection with VOCs, but also low-frequency variants present within the surrounding population. Low-frequency mutations were observed, which have been more recently identified as mutations of interest owing to their location within targeted immune epitopes (P812L) and association with increased replicative capacity (L18F). We present these results to posit the nature of the efficacy of vaccines in reducing symptoms as both a blessing and a curse-as vaccination becomes more widespread and self-motivated testing reduced owing to the absence of severe symptoms, we face the challenge of early recognition of novel mutations of potential concern. This case study highlights the critical need for continued testing and monitoring of infection and transmission among individuals regardless of vaccination status.
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Affiliation(s)
- Brittany R. Magalis
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFloridaUSA
- Department of PathologyUniversity of FloridaGainesvilleFloridaUSA
| | - Carla Mavian
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFloridaUSA
- Department of PathologyUniversity of FloridaGainesvilleFloridaUSA
| | - Massimiliano Tagliamonte
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFloridaUSA
- Department of PathologyUniversity of FloridaGainesvilleFloridaUSA
| | - Shannan N. Rich
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFloridaUSA
- Department of Epidemiology, College of Public Health and Health Professions and College of MedicineUniversity of FloridaGainesvilleFloridaUSA
- Florida Department of HealthGainesvilleFloridaUSA
| | - Melanie Cash
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFloridaUSA
- Department of PathologyUniversity of FloridaGainesvilleFloridaUSA
| | - Alberto Riva
- Interdisciplinary Center for Biotechnology ResearchUniversity of FloridaGainesvilleFloridaUSA
| | - Julia C. Loeb
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFloridaUSA
- Department of Environmental and Global HealthUniversity of FloridaGainesvilleFloridaUSA
| | - Michael Norris
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFloridaUSA
- Department of Environmental and Global HealthUniversity of FloridaGainesvilleFloridaUSA
| | - David M. Amador
- Interdisciplinary Center for Biotechnology ResearchUniversity of FloridaGainesvilleFloridaUSA
| | - Yanping Zhang
- Interdisciplinary Center for Biotechnology ResearchUniversity of FloridaGainesvilleFloridaUSA
| | - Jerne Shapiro
- Department of Epidemiology, College of Public Health and Health Professions and College of MedicineUniversity of FloridaGainesvilleFloridaUSA
- Florida Department of HealthGainesvilleFloridaUSA
| | - Petr Starostik
- Department of PathologyUniversity of FloridaGainesvilleFloridaUSA
| | - Simone Marini
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFloridaUSA
- Department of Epidemiology, College of Public Health and Health Professions and College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Paul Myers
- Florida Department of HealthGainesvilleFloridaUSA
| | - David A. Ostrov
- Department of PathologyUniversity of FloridaGainesvilleFloridaUSA
| | - John A. Lednicky
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFloridaUSA
- Department of Environmental and Global HealthUniversity of FloridaGainesvilleFloridaUSA
| | - J. Glenn Morris
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFloridaUSA
- Division of Infectious Diseases and Global Medicine, College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Michael Lauzardo
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFloridaUSA
- Florida Department of HealthGainesvilleFloridaUSA
- Division of Infectious Diseases and Global Medicine, College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Marco Salemi
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFloridaUSA
- Department of PathologyUniversity of FloridaGainesvilleFloridaUSA
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Stern RA, Charness ME, Gupta K, Koutrakis P, Linsenmeyer K, Madjarov R, Martins MAG, Lemos B, Dowd SE, Garshick E. Concordance of SARS-CoV-2 RNA in Aerosols From a Nurses Station and in Nurses and Patients During a Hospital Ward Outbreak. JAMA Netw Open 2022; 5:e2216176. [PMID: 35675074 PMCID: PMC9178433 DOI: 10.1001/jamanetworkopen.2022.16176] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/22/2022] [Indexed: 12/18/2022] Open
Abstract
Importance Aerosol-borne SARS-CoV-2 has not been linked specifically to nosocomial outbreaks. Objective To explore the genomic concordance of SARS-CoV-2 from aerosol particles of various sizes and infected nurses and patients during a nosocomial outbreak of COVID-19. Design, Setting, and Participants This cohort study included patients and nursing staff in a US Department of Veterans Affairs inpatient hospital unit and long-term-care facility during a COVID-19 outbreak between December 27, 2020, and January 8, 2021. Outbreak contact tracing was conducted using exposure histories and screening with reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2. Size-selective particle samplers were deployed in diverse clinical areas of a multicampus health care system from November 2020 to March 2021. Viral genomic sequences from infected nurses and patients were sequenced and compared with ward nurses station aerosol samples. Exposure SARS-CoV-2. Main Outcomes and Measures The primary outcome was positive RT-PCR results and genomic similarity between SARS-CoV-2 RNA in aerosols and human samples. Air samplers were used to detect SARS-CoV-2 RNA in aerosols on hospital units where health care personnel were or were not under routine surveillance for SARS-CoV-2 infection. Results A total of 510 size-fractionated air particle samples were collected. Samples representing 3 size fractions (>10 μm, 2.5-10 μm, and <2.5 μm) obtained at the nurses station were positive for SARS-CoV-2 during the outbreak (3 of 30 samples [10%]) and negative during 9 other collection periods. SARS-CoV-2 partial genome sequences for the smallest particle fraction were 100% identical with all 3 human samples; the remaining size fractions shared >99.9% sequence identity with the human samples. Fragments of SARS-CoV-2 RNA were detected by RT-PCR in 24 of 300 samples (8.0%) in units where health care personnel were not under surveillance and 7 of 210 samples (3.3%; P = .03) where they were under surveillance. Conclusions and Relevance In this cohort study, the finding of genetically identical SARS-CoV-2 RNA fragments in aerosols obtained from a nurses station and in human samples during a nosocomial outbreak suggests that aerosols may have contributed to hospital transmission. Surveillance, along with ventilation, masking, and distancing, may reduce the introduction of community-acquired SARS-CoV-2 into aerosols on hospital wards, thereby reducing the risk of hospital transmission.
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Affiliation(s)
- Rebecca A. Stern
- Department of Environmental Health, Harvard T.H. Chan School of Public Heath, Boston, Massachusetts
| | - Michael E. Charness
- Veterans Affairs Boston Healthcare System, West Roxbury, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kalpana Gupta
- Veterans Affairs Boston Healthcare System, West Roxbury, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Heath, Boston, Massachusetts
| | - Katherine Linsenmeyer
- Veterans Affairs Boston Healthcare System, West Roxbury, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Rebecca Madjarov
- Veterans Affairs Boston Healthcare System, West Roxbury, Boston, Massachusetts
| | - Marco A. G. Martins
- Department of Environmental Health, Harvard T.H. Chan School of Public Heath, Boston, Massachusetts
| | - Bernardo Lemos
- Department of Environmental Health and Molecular and Integrative Physiological Sciences Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Scot E. Dowd
- Molecular Research LP (MR DNA), Shallowater, Texas
| | - Eric Garshick
- Harvard Medical School, Boston, Massachusetts
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Veterans Affairs Boston Healthcare System, West Roxbury, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Tao Y, Zhang X, Qiu G, Spillmann M, Ji Z, Wang J. SARS-CoV-2 and other airborne respiratory viruses in outdoor aerosols in three Swiss cities before and during the first wave of the COVID-19 pandemic. ENVIRONMENT INTERNATIONAL 2022; 164:107266. [PMID: 35512527 PMCID: PMC9060371 DOI: 10.1016/j.envint.2022.107266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 05/02/2023]
Abstract
Caused by the SARS-CoV-2 virus, Coronavirus disease 2019 (COVID-19) has been affecting the world since the end of 2019. While virus-laden particles have been commonly detected and studied in the aerosol samples from indoor healthcare settings, studies are scarce on air surveillance of the virus in outdoor non-healthcare environments, including the correlations between SARS-CoV-2 and other respiratory viruses, between viruses and environmental factors, and between viruses and human behavior changes due to the public health measures against COVID-19. Therefore, in this study, we collected airborne particulate matter (PM) samples from November 2019 to April 2020 in Bern, Lugano, and Zurich. Among 14 detected viruses, influenza A, HCoV-NL63, HCoV-HKU1, and HCoV-229E were abundant in air. SARS-CoV-2 and enterovirus were moderately common, while the remaining viruses occurred only in low concentrations. SARS-CoV-2 was detected in PM10 (PM below 10 µm) samples of Bern and Zurich, and PM2.5 (PM below 2.5 µm) samples of Bern which exhibited a concentration positively correlated with the local COVID-19 case number. The concentration was also correlated with the concentration of enterovirus which raised the concern of coinfection. The estimated COVID-19 infection risks of an hour exposure at these two sites were generally low but still cannot be neglected. Our study demonstrated the potential functionality of outdoor air surveillance of airborne respiratory viruses, especially at transportation hubs and traffic arteries.
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Affiliation(s)
- Yile Tao
- Institute of Environmental Engineering, ETH Zurich, Zurich 8093, Switzerland; Laboratory for Advanced Analytical Technologies, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf 8600, Switzerland
| | - Xiaole Zhang
- Institute of Environmental Engineering, ETH Zurich, Zurich 8093, Switzerland; Laboratory for Advanced Analytical Technologies, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf 8600, Switzerland
| | - Guangyu Qiu
- Institute of Environmental Engineering, ETH Zurich, Zurich 8093, Switzerland; Laboratory for Advanced Analytical Technologies, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf 8600, Switzerland
| | - Martin Spillmann
- Institute of Environmental Engineering, ETH Zurich, Zurich 8093, Switzerland; Laboratory for Advanced Analytical Technologies, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf 8600, Switzerland
| | - Zheng Ji
- School of Geography and Tourism, Shaanxi Normal University, Xi'an 710119, China
| | - Jing Wang
- Institute of Environmental Engineering, ETH Zurich, Zurich 8093, Switzerland; Laboratory for Advanced Analytical Technologies, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf 8600, Switzerland.
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Coleman KK, Tay DJW, Tan KS, Ong SWX, Than TS, Koh MH, Chin YQ, Nasir H, Mak TM, Chu JJH, Milton DK, Chow VTK, Tambyah PA, Chen M, Tham KW. Viral Load of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Respiratory Aerosols Emitted by Patients With Coronavirus Disease 2019 (COVID-19) While Breathing, Talking, and Singing. Clin Infect Dis 2022; 74:1722-1728. [PMID: 34358292 DOI: 10.1101/2021.07.15.21260561] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) superspreading events suggest that aerosols play an important role in driving the coronavirus disease 2019 (COVID-19) pandemic. To better understand how airborne SARS-CoV-2 transmission occurs, we sought to determine viral loads within coarse (>5 μm) and fine (≤5 μm) respiratory aerosols produced when breathing, talking, and singing. METHODS Using a G-II exhaled breath collector, we measured viral RNA in coarse and fine respiratory aerosols emitted by COVID-19 patients during 30 minutes of breathing, 15 minutes of talking, and 15 minutes of singing. RESULTS Thirteen participants (59%) emitted detectable levels of SARS-CoV-2 RNA in respiratory aerosols, including 3 asymptomatic and 1 presymptomatic patient. Viral loads ranged from 63-5821 N gene copies per expiratory activity per participant, with high person-to-person variation. Patients earlier in illness were more likely to emit detectable RNA. Two participants, sampled on day 3 of illness, accounted for 52% of total viral load. Overall, 94% of SARS-CoV-2 RNA copies were emitted by talking and singing. Interestingly, 7 participants emitted more virus from talking than singing. Overall, fine aerosols constituted 85% of the viral load detected in our study. Virus cultures were negative. CONCLUSIONS Fine aerosols produced by talking and singing contain more SARS-CoV-2 copies than coarse aerosols and may play a significant role in SARS-CoV-2 transmission. Exposure to fine aerosols, especially indoors, should be mitigated. Isolating viable SARS-CoV-2 from respiratory aerosol samples remains challenging; whether this can be more easily accomplished for emerging SARS-CoV-2 variants is an urgent enquiry necessitating larger-scale studies.
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Affiliation(s)
- Kristen K Coleman
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Douglas Jie Wen Tay
- Department of the Built Environment, National University of Singapore, Singapore
| | - Kai Sen Tan
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Biosafety Level 3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Sean Wei Xiang Ong
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - The Son Than
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
- Department of the Built Environment, National University of Singapore, Singapore
| | - Ming Hui Koh
- Department of the Built Environment, National University of Singapore, Singapore
| | - Yi Qing Chin
- National Centre for Infectious Diseases, Singapore
| | - Haziq Nasir
- Division of Infectious Diseases, Department of Medicine, National University Health System, National University of Singapore, Singapore
| | - Tze Minn Mak
- National Centre for Infectious Diseases, Singapore
| | - Justin Jang Hann Chu
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Biosafety Level 3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Vincent T K Chow
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Paul Anantharajah Tambyah
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Health System, National University of Singapore, Singapore
| | - Mark Chen
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kwok Wai Tham
- Department of the Built Environment, National University of Singapore, Singapore
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139
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Massicotte R, Assanta MA, Rosette KM. Importance of the Precautionary Principle With Regard to the Risk of Exposure to Aerosols Containing Viral Loads of SARS-CoV-2 Present in Feces: In Perspective. Front Public Health 2022; 10:892290. [PMID: 35692325 PMCID: PMC9174678 DOI: 10.3389/fpubh.2022.892290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
In COVID-19 infection, the emissions of droplets and aerosols produced by the respiratory tract of contaminated subjects may represent a high risk of spreading the SARS-COV-2 virus in the environment. Thus, studies have shown that there is, at least, another source of droplets and aerosols in which viral particles of SARS-COV-2 can be found. It happens after flushing of toilet to dispose of the stools of a patient who has contracted COVID-19. The presence of viral particles of SARS-COV-2 in the stool could be linked to the concentration of angiotensin-converting enzyme 2 (ACE2) found on the surface of intestinal cells. Therefore, there is a reason to wonder whether the emission of viral particles by activating a toilet flush could represent an important potential risk of contamination for health care workers. To investigate this hypothesis, we have correlated different studies on the production of droplets and aerosols as well as the presence of viral particles following flush of toilet. This pooling of these studies led to the following conclusion: the precautionary principle should be applied with regard to the potential risk represented by viral particles of SARV-COV-2 in the stool when flushing the toilet.
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Affiliation(s)
- Richard Massicotte
- Laboratory of Innovation and Analysis of Bioperformance, Ecole Polytechnique de Montreal, Montreal, QC, Canada
| | - Mafu Akier Assanta
- Food Research and Development Centre, Agriculture and Agri-Food Canada, Saint-Hyacinthe, QC, Canada
| | - Kakese Mukosa Rosette
- Groupe de Recherche sur les Maladies Infectieuses du Porc, Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Centre de Recherche d'Infectiologie Porcine et Avicole, Université de Montréal, Saint-Hyacinthe, QC, Canada
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140
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Andalib E, Faghani M, Zia Ziabari SM, Shenagari M, Salehiniya H, Keivanlou MH, Rafat Z. The Effectiveness of the Anteroom (Vestibule) Area on Hospital Infection Control and Health Staff Safety: A Systematic Review. Front Public Health 2022; 10:828845. [PMID: 35558527 PMCID: PMC9086672 DOI: 10.3389/fpubh.2022.828845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/22/2022] [Indexed: 01/22/2023] Open
Abstract
The emergence of SARS-CoV2 in 2019 showed again that the world's healthcare system is not fully equipped and well-designed for preventing the transmission of nosocomial respiratory infections. One of the great tools for preventing the spread of infectious organisms in hospitals is the anteroom. Several articles have investigated the role of the anteroom in disease control but the lack of a comprehensive study in this field prompted us to provide more in-depth information to fill this gap. Also, this study aimed to assess the necessity to construct an anteroom area for hospital staff members at the entrance of each ward of the hospital, and specify the equipment and facilities which make the anteroom more efficient. Articles were identified through searches of Scopus, Web of Sciences, PubMed, and Embase for studies published in English until May 2020 reporting data on the effect of the anteroom (vestibule) area in controlling hospital infections. Data from eligible articles were extracted and presented according to PRISMA's evidence-based data evaluation search strategy. Also, details around the review aims and methods were registered with the PROSPERO. From the database, 209 articles were identified, of which 25 studies met the study criteria. Most studies demonstrated that an anteroom significantly enhances practical system efficiency. The results showed that the equipment such as ventilation system, high-efficiency particulate absorption filter, hand dispensers, alcohol-based disinfection, sink, mirror, transparent panel, UVC disinfection, and zone for PPE change, and parameters like temperature, door type, pressure, and size of the anteroom are factors that are effective on the safety of the hospital environment. Studies demonstrated that providing an anteroom for changing clothing and storing equipment may be useful in reducing the transmission of airborne infections in hospitals. Since the transmission route of SARS-CoV2 is common with other respiratory infectious agents, it can be concluded that a well-designed anteroom could potentially decrease the risk of SARS-CoV2 transmission during hospitalization as well.
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Affiliation(s)
- Elham Andalib
- Department of Design, Faculty of Fine Art, Music and Design, University of Bergen, Bergen, Norway.,Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoumeh Faghani
- Department of Anatomy, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyyed Mahdi Zia Ziabari
- Department of Emergency Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Shenagari
- Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Zahra Rafat
- Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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141
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Döhla M, Schulte B, Wilbring G, Kümmerer BM, Döhla C, Sib E, Richter E, Ottensmeyer PF, Haag A, Engelhart S, Eis-Hübinger AM, Exner M, Mutters NT, Schmithausen RM, Streeck H. SARS-CoV-2 in Environmental Samples of Quarantined Households. Viruses 2022; 14:1075. [PMID: 35632816 PMCID: PMC9147922 DOI: 10.3390/v14051075] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 02/01/2023] Open
Abstract
The role of environmental transmission of SARS-CoV-2 remains unclear. Thus, the aim of this study was to investigate whether viral contamination of air, wastewater, and surfaces in quarantined households result in a higher risk for exposed persons. For this study, a source population of 21 households under quarantine conditions with at least one person who tested positive for SARS-CoV-2 RNA were randomly selected from a community in North Rhine-Westphalia in March 2020. All individuals living in these households participated in this study and provided throat swabs for analysis. Air and wastewater samples and surface swabs were obtained from each household and analysed using qRT-PCR. Positive swabs were further cultured to analyse for viral infectivity. Out of all the 43 tested adults, 26 (60.47%) tested positive using qRT-PCR. All 15 air samples were qRT-PCR-negative. In total, 10 out of 66 wastewater samples were positive for SARS-CoV-2 (15.15%) and 4 out of 119 surface samples (3.36%). No statistically significant correlation between qRT-PCR-positive environmental samples and the extent of the spread of infection between household members was observed. No infectious virus could be propagated under cell culture conditions. Taken together, our study demonstrates a low likelihood of transmission via surfaces. However, to definitively assess the importance of hygienic behavioural measures in the reduction of SARS-CoV-2 transmission, larger studies should be designed to determine the proportionate contribution of smear vs. droplet transmission.
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Affiliation(s)
- Manuel Döhla
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Rübenacher Straße 170, 56072 Koblenz, Germany
| | - Bianca Schulte
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (B.S.); (B.M.K.); (E.R.); (P.F.O.); (A.M.E.-H.)
| | - Gero Wilbring
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Beate Mareike Kümmerer
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (B.S.); (B.M.K.); (E.R.); (P.F.O.); (A.M.E.-H.)
| | - Christin Döhla
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Esther Sib
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Enrico Richter
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (B.S.); (B.M.K.); (E.R.); (P.F.O.); (A.M.E.-H.)
| | - Patrick Frank Ottensmeyer
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (B.S.); (B.M.K.); (E.R.); (P.F.O.); (A.M.E.-H.)
| | - Alexandra Haag
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Anna Maria Eis-Hübinger
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (B.S.); (B.M.K.); (E.R.); (P.F.O.); (A.M.E.-H.)
| | - Martin Exner
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Nico Tom Mutters
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Ricarda Maria Schmithausen
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.D.); (G.W.); (C.D.); (E.S.); (A.H.); (S.E.); (M.E.); (N.T.M.); (R.M.S.)
| | - Hendrik Streeck
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (B.S.); (B.M.K.); (E.R.); (P.F.O.); (A.M.E.-H.)
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Döhla M, Schulte B, Wilbring G, Kümmerer BM, Döhla C, Sib E, Richter E, Ottensmeyer PF, Haag A, Engelhart S, Eis-Hübinger AM, Exner M, Mutters NT, Schmithausen RM, Streeck H. SARS-CoV-2 in Environmental Samples of Quarantined Households. Viruses 2022. [PMID: 35632816 DOI: 10.1101/2020.05.28.20114041] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
The role of environmental transmission of SARS-CoV-2 remains unclear. Thus, the aim of this study was to investigate whether viral contamination of air, wastewater, and surfaces in quarantined households result in a higher risk for exposed persons. For this study, a source population of 21 households under quarantine conditions with at least one person who tested positive for SARS-CoV-2 RNA were randomly selected from a community in North Rhine-Westphalia in March 2020. All individuals living in these households participated in this study and provided throat swabs for analysis. Air and wastewater samples and surface swabs were obtained from each household and analysed using qRT-PCR. Positive swabs were further cultured to analyse for viral infectivity. Out of all the 43 tested adults, 26 (60.47%) tested positive using qRT-PCR. All 15 air samples were qRT-PCR-negative. In total, 10 out of 66 wastewater samples were positive for SARS-CoV-2 (15.15%) and 4 out of 119 surface samples (3.36%). No statistically significant correlation between qRT-PCR-positive environmental samples and the extent of the spread of infection between household members was observed. No infectious virus could be propagated under cell culture conditions. Taken together, our study demonstrates a low likelihood of transmission via surfaces. However, to definitively assess the importance of hygienic behavioural measures in the reduction of SARS-CoV-2 transmission, larger studies should be designed to determine the proportionate contribution of smear vs. droplet transmission.
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Affiliation(s)
- Manuel Döhla
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Rübenacher Straße 170, 56072 Koblenz, Germany
| | - Bianca Schulte
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Gero Wilbring
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Beate Mareike Kümmerer
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christin Döhla
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Esther Sib
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Enrico Richter
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | | | - Alexandra Haag
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Anna Maria Eis-Hübinger
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Nico Tom Mutters
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ricarda Maria Schmithausen
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Hendrik Streeck
- Institute of Virology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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143
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Zafari Z, de Oliveira PM, Gkantonas S, Ezeh C, Muennig PA. The cost-effectiveness of standalone HEPA filtration units for the prevention of airborne SARS CoV-2 transmission. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:22. [PMID: 35549719 PMCID: PMC9096756 DOI: 10.1186/s12962-022-00356-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Airborne infection from aerosolized SARS-CoV-2 poses an economic challenge for businesses without existing heating, ventilation, and air conditioning (HVAC) systems. The Environmental Protection Agency notes that standalone units may be used in areas without existing HVAC systems, but the cost and effectiveness of standalone units has not been evaluated. STUDY DESIGN Cost-effectiveness analysis with Monte Carlo simulation and aerosol transmission modeling. METHODS We built a probabilistic decision-analytic model in a Monte Carlo simulation that examines aerosol transmission of SARS-CoV-2 in an indoor space. As a base case study, we built a model that simulated a poorly ventilated indoor 1000 square foot restaurant and the range of Covid-19 prevalence of actively infectious cases (best-case: 0.1%, base-case: 2%, and worst-case: 3%) and vaccination rates (best-case: 90%, base-case: 70%, and worst-case: 0%) in New York City. We evaluated the cost-effectiveness of improving ventilation rate to 12 air changes per hour (ACH), the equivalent of hospital-grade filtration systems used in emergency departments. We also provide a customizable online tool that allows the user to change model parameters. RESULTS All 3 scenarios resulted in a net cost-savings and infections averted. For the base-case scenario, improving ventilation to 12 ACH was associated with 54 [95% Credible Interval (CrI): 29-86] aerosol infections averted over 1 year, producing an estimated cost savings of $152,701 (95% CrI: $80,663, $249,501) and 1.35 (95% CrI: 0.72, 2.24) quality-adjusted life years (QALYs) gained. CONCLUSIONS It is cost-effective to improve indoor ventilation in small businesses in older buildings that lack HVAC systems during the pandemic.
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Affiliation(s)
- Zafar Zafari
- Department of Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, 21201, USA.
| | | | - Savvas Gkantonas
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Chinenye Ezeh
- Mailman School of Public Health, Columbia University, New York, NY, USA
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144
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Horve PF, Dietz LG, Bowles G, MacCrone G, Olsen-Martinez A, Northcutt D, Moore V, Barnatan L, Parhizkar H, Van Den Wymelenberg KG. Longitudinal analysis of built environment and aerosol contamination associated with isolated COVID-19 positive individuals. Sci Rep 2022; 12:7395. [PMID: 35513399 PMCID: PMC9070971 DOI: 10.1038/s41598-022-11303-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/12/2022] [Indexed: 12/13/2022] Open
Abstract
The indoor environment is the primary location for the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), largely driven by respiratory particle accumulation in the air and increased connectivity between the individuals occupying indoor spaces. In this study, we aimed to track a cohort of subjects as they occupied a COVID-19 isolation dormitory to better understand the impact of subject and environmental viral load over time, symptoms, and room ventilation on the detectable viral load within a single room. We find that subject samples demonstrate a decrease in overall viral load over time, symptoms significantly impact environmental viral load, and we provide the first real-world evidence for decreased aerosol SARS-CoV-2 load with increasing ventilation, both from mechanical and window sources. These results may guide environmental viral surveillance strategies and be used to better control the spread of SARS-CoV-2 within built environments and better protect those caring for individuals with COVID-19.
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Affiliation(s)
- Patrick F Horve
- Institute of Molecular Biology, University of Oregon, Eugene, OR, 97403, USA
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
| | - Leslie G Dietz
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
| | - Garis Bowles
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
| | - Georgia MacCrone
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
| | | | - Dale Northcutt
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
- Energy Studies in Buildings Laboratory, University of Oregon, Eugene, OR, 97403, USA
| | - Vincent Moore
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
| | - Liliana Barnatan
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
| | - Hooman Parhizkar
- Energy Studies in Buildings Laboratory, University of Oregon, Eugene, OR, 97403, USA
- Institute for Health and the Built Environment, University of Oregon, Portland, OR, 97209, USA
| | - Kevin G Van Den Wymelenberg
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA.
- Energy Studies in Buildings Laboratory, University of Oregon, Eugene, OR, 97403, USA.
- Institute for Health and the Built Environment, University of Oregon, Portland, OR, 97209, USA.
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145
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Nagle S, Tandjaoui-Lambiotte Y, Boubaya M, Gerber A, Alloui C, Bloch-Queyrat C, Carbonnelle E, Brichler S, Cohen Y, Zahar JR, Delagrèverie H. Environmental SARS-CoV-2 contamination in hospital rooms of patients with acute COVID-19. J Hosp Infect 2022; 126:116-122. [PMID: 35569577 PMCID: PMC9098885 DOI: 10.1016/j.jhin.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 12/19/2022]
Abstract
Objective Data on the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) remain conflicting. Airborne transmission is still debated. However, hospital risk control requires better understanding of the different modes of transmission. This study aimed to evaluate the frequency of, and factors associated with, environmental air and surface contamination in the rooms of patients with coronavirus disease 2019 in the acute phase of the disease. Methods Sixty-five consecutive patients were included in this study. For each patient, seven room surfaces, air 1 m and 3 m from the patient's head, the inner surface of the patient's mask, and the outer surface of healthcare workers' (HCW) masks were sampled. Environmental contamination was assessed by quantitative reverse transcription polymerase chain reaction (RT-qPCR) for SARS-CoV-2 RNA on surfaces, air and masks. A viral isolation test was performed on Vero cells for samples with an RT-qPCR cycle threshold (Ct) ≤37. Results SARS-CoV-2 RNA was detected by RT-qPCR in 34%, 12%, 50% and 10% of surface, air, patient mask and HCW mask samples, respectively. Infectious virus was isolated in culture from two samples among the 85 positive samples with Ct ≤37. On multi-variate analysis, only a positive result for SARS-CoV-2 RT-qPCR for patients' face masks was found to be significantly associated with surface contamination (odds ratio 5.79, 95% confidence interval 1.31–25.67; P=0.025). Conclusion This study found that surface contamination by SARS-CoV-2 was more common than air and mask contamination. However, viable virus was rare. The inner surface of a patient's mask could be used as a marker to identify those at higher risk of contamination.
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146
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Stettler MEJ, Nishida RT, de Oliveira PM, Mesquita LCC, Johnson TJ, Galea ER, Grandison A, Ewer J, Carruthers D, Sykes D, Kumar P, Avital E, Obeysekara AIB, Doorly D, Hardalupas Y, Green DC, Coldrick S, Parker S, Boies AM. Source terms for benchmarking models of SARS-CoV-2 transmission via aerosols and droplets. ROYAL SOCIETY OPEN SCIENCE 2022. [PMID: 35592762 DOI: 10.6084/m9.figshare.c.5958950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
There is ongoing and rapid advancement in approaches to modelling the fate of exhaled particles in different environments relevant to disease transmission. It is important that models are verified by comparison with each other using a common set of input parameters to ensure that model differences can be interpreted in terms of model physics rather than unspecified differences in model input parameters. In this paper, we define parameters necessary for such benchmarking of models of airborne particles exhaled by humans and transported in the environment during breathing and speaking.
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Affiliation(s)
- Marc E J Stettler
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Robert T Nishida
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2G8
| | | | - Léo C C Mesquita
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Tyler J Johnson
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Edwin R Galea
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - Angus Grandison
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - John Ewer
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - David Carruthers
- Cambridge Environmental Research Consultants Ltd, 3 Kings Parade, Cambridge CB2 1SJ, UK
| | | | - Prashant Kumar
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Eldad Avital
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - Asiri I B Obeysekara
- Applied Modelling and Computation Group, Department of Earth Science and Engineering, Imperial College London, London SW7 2AZ, UK
| | - Denis Doorly
- Department of Aeronautics, Imperial College London, London SW7 2AZ, UK
| | - Yannis Hardalupas
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - David C Green
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, Michael Uren Biomedical Engineering Hub, London, W12 OBZ, UK
- NIHR HPRU in Environmental Exposures and Health, Imperial College London, Michael Uren Biomedical Engineering Hub, London, W12 OBZ, UK
| | - Simon Coldrick
- Health and Safety Executive, Harpur Hill, Buxton, Derbyshire SK17 9JN UK
| | - Simon Parker
- Defence Science and Technology Laboratory, Porton Down, Salisbury SP4 0JQ, UK
| | - Adam M Boies
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
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147
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Stettler MEJ, Nishida RT, de Oliveira PM, Mesquita LCC, Johnson TJ, Galea ER, Grandison A, Ewer J, Carruthers D, Sykes D, Kumar P, Avital E, Obeysekara AIB, Doorly D, Hardalupas Y, Green DC, Coldrick S, Parker S, Boies AM. Source terms for benchmarking models of SARS-CoV-2 transmission via aerosols and droplets. ROYAL SOCIETY OPEN SCIENCE 2022; 9:212022. [PMID: 35592762 PMCID: PMC9066307 DOI: 10.1098/rsos.212022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/13/2022] [Indexed: 05/03/2023]
Abstract
There is ongoing and rapid advancement in approaches to modelling the fate of exhaled particles in different environments relevant to disease transmission. It is important that models are verified by comparison with each other using a common set of input parameters to ensure that model differences can be interpreted in terms of model physics rather than unspecified differences in model input parameters. In this paper, we define parameters necessary for such benchmarking of models of airborne particles exhaled by humans and transported in the environment during breathing and speaking.
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Affiliation(s)
- Marc E. J. Stettler
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Robert T. Nishida
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2G8
| | | | - Léo C. C. Mesquita
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Tyler J. Johnson
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Edwin R. Galea
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - Angus Grandison
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - John Ewer
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - David Carruthers
- Cambridge Environmental Research Consultants Ltd, 3 Kings Parade, Cambridge CB2 1SJ, UK
| | | | - Prashant Kumar
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Eldad Avital
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - Asiri I. B. Obeysekara
- Applied Modelling and Computation Group, Department of Earth Science and Engineering, Imperial College London, London SW7 2AZ, UK
| | - Denis Doorly
- Department of Aeronautics, Imperial College London, London SW7 2AZ, UK
| | - Yannis Hardalupas
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - David C. Green
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, Michael Uren Biomedical Engineering Hub, London, W12 OBZ, UK
- NIHR HPRU in Environmental Exposures and Health, Imperial College London, Michael Uren Biomedical Engineering Hub, London, W12 OBZ, UK
| | - Simon Coldrick
- Health and Safety Executive, Harpur Hill, Buxton, Derbyshire SK17 9JN UK
| | - Simon Parker
- Defence Science and Technology Laboratory, Porton Down, Salisbury SP4 0JQ, UK
| | - Adam M. Boies
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
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148
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A Review on Building Design as a Biomedical System for Preventing COVID-19 Pandemic. BUILDINGS 2022. [DOI: 10.3390/buildings12050582] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Sustainable design methods aim to obtain architectural solutions that assure the coexistence and welfare of human beings, inorganic structures, and living things that constitute ecosystems. The novel coronavirus emergence, inadequate vaccines against the present severe acute respiratory syndrome-coronavirus-(SARS-CoV-2), and increases in microbial resistance have made it essential to review the preventative approaches used during pre-antibiotic periods. Apart from low carbon emissions and energy, sustainable architecture for facilities, building designs, and digital modeling should incorporate design approaches to confront the impacts of communicable infections. This review aims to determine how architectural design can protect people and employees from harm; it models viewpoints to highlight the architects’ roles in combating coronavirus disease 2019 (COVID-19) and designing guidelines as a biomedical system for policymakers. The goals include exploring the hospital architecture evolution and the connection between architectural space and communicable infections and recommending design and digital modeling strategies to improve infection prevention and controls. Based on a wide-ranging literature review, it was found that design methods have often played important roles in the prevention and control of infectious diseases and could be a solution for combating the wide spread of the novel coronavirus or coronavirus variants or delta.
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149
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Innate and Adaptive Immune Responses in the Upper Respiratory Tract and the Infectivity of SARS-CoV-2. Viruses 2022; 14:v14050933. [PMID: 35632675 PMCID: PMC9143801 DOI: 10.3390/v14050933] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 02/01/2023] Open
Abstract
Increasing evidence shows the nasal epithelium to be the initial site of SARS-CoV-2 infection, and that early and effective immune responses in the upper respiratory tract (URT) limit and eliminate the infection in the URT, thereby preventing infection of the lower respiratory tract and the development of severe COVID-19. SARS-CoV-2 interferes with innate immunity signaling and evolves mutants that can reduce antibody-mediated immunity in the URT. Recent genetic and immunological advances in understanding innate immunity to SARS-CoV-2 in the URT, and the ability of prior infections as well as currently available injectable and potential intranasal COVID-19 vaccines to generate anamnestic adaptive immunity in the URT, are reviewed. It is suggested that the more detailed investigation of URT immune responses to all types of COVID-19 vaccines, and the development of safe and effective COVID-19 vaccines for intranasal administration, are important needs.
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150
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Ueki H, Ito M, Furusawa Y, Yamayoshi S, Inoue SI, Kawaoka Y. A 265-Nanometer High-Power Deep-UV Light-Emitting Diode Rapidly Inactivates SARS-CoV-2 Aerosols. mSphere 2022; 7:e0094121. [PMID: 35475734 PMCID: PMC9044969 DOI: 10.1128/msphere.00941-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19) is an acute respiratory infection transmitted by droplets, aerosols, and contact. Controlling the spread of COVID-19 and developing effective decontamination options are urgent issues for the international community. Here, we report the quantitative inactivation of SARS-CoV-2 in liquid and aerosolized samples by a state-of-the-art, high-power, AlGaN-based, single-chip compact deep-UV (DUV) light-emitting diode (LED) that produces a record continuous-wave output power of 500 mW at its peak emission wavelength of 265 nm. Using this DUV-LED, we observed a greater-than-5-log reduction in infectious SARS-CoV-2 in liquid samples within very short irradiation times (<0.4 s). When we quantified the efficacy of the 265-nm DUV-LED in inactivating SARS-CoV-2, we found that DUV-LED inactivation of aerosolized SARS-CoV-2 was approximately nine times greater than that of SARS-CoV-2 suspension. Our data demonstrate that this newly developed, compact, high-power 265-nm DUV-LED irradiation system with remarkably high inactivation efficiency for aerosolized SARS-CoV-2 could be an effective and practical tool for controlling SARS-CoV-2 spread. IMPORTANCE We developed a 265-nm high-power DUV-LED irradiation system and quantitatively demonstrated that the DUV-LED can inactivate SARS-CoV-2 in suspensions and aerosols within very short irradiation times. We also found that the inactivation effect was about nine times greater against aerosolized SARS-CoV-2 than against SARS-CoV-2 suspensions. The DUV-LED has several advantages over conventional LEDs and mercury lamps, including high power, compactness, and environmental friendliness; its rapid inactivation of aerosolized SARS-CoV-2 opens up new possibilities for the practical application of DUV-LEDs in high-efficiency air purification systems to control airborne transmission of SARS-CoV-2.
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Affiliation(s)
- Hiroshi Ueki
- Department of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- Center for Global Viral Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mutsumi Ito
- Department of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Yuri Furusawa
- Department of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- Laboratory of Ultrastructural Virology, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Seiya Yamayoshi
- Department of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- Center for Global Viral Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shin-ichiro Inoue
- Advanced ICT Research Institute, National Institute of Information and Communications Technology (NICT), Kobe, Japan
| | - Yoshihiro Kawaoka
- Department of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- Center for Global Viral Diseases, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Special Pathogens, International Research Center for Infectious Diseases, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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