1
|
Pan D, Williams C, Decker J, Fletcher E, Grolmusova N, Bird PW, Martin CA, Nazareth J, Rahman L, O'Kelly K, Panchal R, Musa I, Dhutia H, Sze S, Pareek M, Barer MR. Implementation of facemask sampling for the detection of infectious individuals with SARS-CoV-2 in high stakes clinical examinations - a feasibility study. Future Healthc J 2024; 11:100175. [PMID: 39346932 PMCID: PMC11437942 DOI: 10.1016/j.fhj.2024.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 08/03/2024] [Accepted: 08/27/2024] [Indexed: 10/01/2024]
Abstract
Introduction SARS-CoV-2 may transmit across vaccinated cohorts during practical clinical examinations. We sought to assess the feasibility of facemask sampling (FMS) to identify individuals emitting SARS-CoV-2 during a mock PACES exam. Methods In May 2022 we recruited participants from a mock PACES examination in Leicester, UK. Following a negative lateral flow test assay, all participants wore modified facemasks able to capture exhaled virus during the assessment (FMS). A concomitant upper respiratory tract sample (URTS) was provided prior to FMS. Exposed facemasks were processed by removal and dissolution of sampling matrices fixed within the mask and cycle thresholds values quantified by RT-qPCR. Participants were asked to grade statements regarding the comfort, effort, ethics and communication when providing FMS; laboratory technicians were asked to grade key statements surrounding suitability of samples for processing. Results 34 participants provided concomitant URTS and FMS during the examination. One participant was positive for SARS-CoV-2, with a cycle threshold value of 22.5 on URTS, but negative (no viral RNA detected) on FMS; no transmission to others was identified from this individual. Participants responded positively to statements regarding FMS describing all four domains; however, 69% of participants felt that a positive result from FMS alone was insufficient for diagnosis and that further tests were required. All but one FMS sample was suitable for processing. Discussion FMS during PACES exams are acceptable among participants and samples provided are suitable for processing. Our results demonstrate feasibility of FMS within practical examination settings and support the further assessment of FMS as a scalable tool that can be compared with URTS to identify those who are infectious.
Collapse
Affiliation(s)
- Daniel Pan
- Development Centre for Population Health, University of Leicester, UK
- Department of Respiratory Sciences, University of Leicester, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- NIHR Leicester Biomedical Research Centre, UK
- Li Ka Shing Centre for Health Information and Discovery, University of Oxford, UK
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Sing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Caroline Williams
- Department of Respiratory Sciences, University of Leicester, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- Department of Microbiology, University Hospitals of Leicester NHS Trust, UK
| | - Jonathan Decker
- Department of Respiratory Sciences, University of Leicester, UK
| | - Eve Fletcher
- Department of Respiratory Sciences, University of Leicester, UK
- NIHR Leicester Biomedical Research Centre, UK
| | - Natalia Grolmusova
- Department of Respiratory Sciences, University of Leicester, UK
- NIHR Leicester Biomedical Research Centre, UK
| | - Paul W Bird
- Department of Respiratory Sciences, University of Leicester, UK
- Department of Microbiology, University Hospitals of Leicester NHS Trust, UK
| | - Christopher A Martin
- Development Centre for Population Health, University of Leicester, UK
- Department of Respiratory Sciences, University of Leicester, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- NIHR Leicester Biomedical Research Centre, UK
| | - Joshua Nazareth
- Development Centre for Population Health, University of Leicester, UK
- Department of Respiratory Sciences, University of Leicester, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- NIHR Leicester Biomedical Research Centre, UK
| | - Latif Rahman
- Department of Acute Medicine, University Hospitals of Leicester NHS Trust, UK
| | - Kate O'Kelly
- Department of Geriatric Medicine, University Hospitals of Leicester NHS Trust, UK
| | - Rakesh Panchal
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, UK
| | - Irfana Musa
- Department of Geriatric Medicine, University Hospitals of Leicester NHS Trust, UK
| | - Harshil Dhutia
- Department of Cardiology, University Hospitals of Leicester NHS Trust, UK
| | - Shirley Sze
- Department of Cardiology, University Hospitals of Leicester NHS Trust, UK
- Department of Cardiovascular Sciences, University of Leicester, UK
| | - Manish Pareek
- Development Centre for Population Health, University of Leicester, UK
- Department of Respiratory Sciences, University of Leicester, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- NIHR Leicester Biomedical Research Centre, UK
| | - Michael R Barer
- Department of Respiratory Sciences, University of Leicester, UK
- Department of Microbiology, University Hospitals of Leicester NHS Trust, UK
| |
Collapse
|
2
|
Wang X, Thwin O, Haq Z, Dong Z, Tisdale L, Fuentes LR, Grobe N, Kotanko P. Testing of worn face mask and saliva for SARS-CoV-2. Front Public Health 2023; 11:1237512. [PMID: 37790720 PMCID: PMC10545089 DOI: 10.3389/fpubh.2023.1237512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Background Exhaled SARS-CoV-2 can be detected on face masks. We compared tests for SARS-CoV-2 RNA on worn face masks and matched saliva samples. Methods We conducted this prospective, observational, case-control study between December 2021 and March 2022. Cases comprised 30 in-center hemodialysis patients with recent COVID-19 diagnosis. Controls comprised 13 hemodialysis patients and 25 clinic staff without COVID-19 during the study period and the past 2 months. Disposable 3-layer masks were collected after being worn for 4 hours together with concurrent saliva samples. ThermoFisher COVID-19 Combo Kit (A47814) was used for RT-PCR testing. Results Mask and saliva testing specificities were 99% and 100%, respectively. Test sensitivity was 62% for masks, and 81% for saliva (p = 0.16). Median viral RNA shedding duration was 11 days and longer in immunocompromised versus non-immunocompromised patients (22 vs. 11 days, p = 0.06, log-rank test). Conclusion While SARS-CoV-2 testing on worn masks appears to be less sensitive compared to saliva, it may be a preferred screening method for individuals who are mandated to wear masks yet averse to more invasive sampling. However, optimized RNA extraction methods and automated procedures are warranted to increase test sensitivity and scalability. We corroborated longer viral RNA shedding in immunocompromised patients.
Collapse
Affiliation(s)
- Xiaoling Wang
- Renal Research Institute, New York, NY, United States
| | - Ohnmar Thwin
- Renal Research Institute, New York, NY, United States
| | - Zahin Haq
- Renal Research Institute, New York, NY, United States
| | - Zijun Dong
- Renal Research Institute, New York, NY, United States
| | - Lela Tisdale
- Renal Research Institute, New York, NY, United States
| | | | - Nadja Grobe
- Renal Research Institute, New York, NY, United States
| | - Peter Kotanko
- Renal Research Institute, New York, NY, United States
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
3
|
Kim HS, Lee H, Kang S, Kim WJ, Shin S. Diagnostic performance of respirators for collection and detection of SARS-CoV-2. Sci Rep 2023; 13:13277. [PMID: 37582958 PMCID: PMC10427661 DOI: 10.1038/s41598-023-39789-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023] Open
Abstract
Respirators, called as face mask, have been used to protect the wearer from the outside harmful air environment and prevent any virus from being released to neighbors from potentially infected exhaled breath. The antiviral effectiveness of respirators has not only been researched scientifically, but has also become a global issue due to society's obligation to wear respirators. In this paper, we report the results of a study on the collection and detection of viruses contained in exhaled breath using respirators. The inner electrostatic filter was carefully selected for virus collection because it does not come in direct contact with either human skin or the external environment. In the study of a healthy control group, it was confirmed that a large amount of DNA and biomolecules such as exosomes were collected from the respirator exposed to exhalation, and the amount of collection increased in proportion to the wearing time. We conducted experiments using a total of 72 paired samples with nasopharyngeal swabs and respirator samples. Out of these samples, fifty tested positive for SARS-CoV-2 and twenty-two tested negative. The PCR results of the NPS and respirator samples showed a high level of agreement, with a positive percent agreement of ≥ 90% and a negative percent agreement of ≥ 99%. Furthermore, there was a notable level of concordance between RCA-flow tests and PCR when examining the respirator samples. These results suggest that this is a non-invasive, quick and easy method of collecting samples from subjects using a respirator, which can significantly reduce the hassle of waiting at airports or public places and concerns about cross-contamination. Furthermore, we expect miniaturized technologies to integrate PCR detection into respirators in the near future.
Collapse
Affiliation(s)
- Hwang-Soo Kim
- Department of Micro-nano System Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Hansol Lee
- Asia Pacific Influenza Institute, Korea University College of Medicine, Seoul, 08308, Republic of Korea
| | - Seonghui Kang
- Division of Infectious Diseases, Department of Internal Medicine, Konyang University Hospital, Daejeon, 35365, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, 08308, Republic of Korea.
| | - Sehyun Shin
- Department of Micro-nano System Engineering, Korea University, Seoul, 02841, Republic of Korea.
- School of Mechanical Engineering, Korea University, Seoul, 02841, Republic of Korea.
| |
Collapse
|
4
|
Vishnoi J, Sharma RK, Patel J, Sharma JC, Sharma KR, Mehta U. Severity and Outcome of Post-Vaccine COVID-19 among Healthcare Workers in a University Hospital in India. J Med Life 2023; 16:782-793. [PMID: 37520491 PMCID: PMC10375337 DOI: 10.25122/jml-2023-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/29/2023] [Indexed: 08/01/2023] Open
Abstract
Healthcare workers (HCWs) are at high risk of COVID-19 infection despite vaccination. Limited data exist on COVID-19 cases among vaccinated HCWs. This study aimed to describe the clinical characteristics and outcomes of RT PCR-confirmed COVID-19 cases in vaccinated HCWs, at a COVID clinic in a medical college hospital. This single-center, prospective cohort study included HCWs who received at least one dose of the COVID-19 vaccine and tested positive for COVID-19 within 6 months. Data on demographics, symptoms, work category, COVID-19 vaccination interval, and infection severity were collected. Of 2381 vaccinated HCWs, 105 tested positive and were categorized as mild, moderate, or severe cases. Among vaccinated HCWs, 4.41% had post-vaccine COVID-19 infections. All 105 cases received the first dose, and 79 received the second dose. Of the cases, 47.6% were partially vaccinated, and 53.3% were breakthrough cases. The mean age was 30.90±8.69 years, with 63.8% male and 36.2% female cases. Most cases (85.7%) acquired infection in the hospital, and 47.6% had direct contact with COVID-19 patients. Common symptoms included fatigue (85.7%), fever (82.9%), and cough (64.8%). Among cases, 93.3% were mild, 5.7% were moderate, and 0.9% were severe. Hospital admission and supplemental oxygen therapy were required for moderate and severe cases. No mortality was reported. Certain variables were associated with age, preventive measures, workplace type, symptoms, and comorbidities. Breakthrough infections can occur among fully vaccinated HCWs but with reduced severity and mortality. Monitoring and infection control measures remain crucial even in vaccinated individuals. This study provides insights into clinical presentations, oxygen therapy requirements, and outcomes of post-vaccine COVID-19 cases among HCWs. The data will inform strategies for booster doses to prevent COVID-19.
Collapse
Affiliation(s)
- Jagdish Vishnoi
- Department of Medicine, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India
| | - Rajendra Kumar Sharma
- Department of Pediatrics, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India
| | - Japan Patel
- Department of Medicine, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India
| | - Jagdish Chandra Sharma
- Department of Medicine, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India
| | - Kalu Ram Sharma
- Department of Medicine, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India
| | - Urvansh Mehta
- Department of Medicine, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India
| |
Collapse
|
5
|
Liu X, Hu B. Mask device as a new wearable sampler for breath analysis: what can we expect in the future? Anal Bioanal Chem 2023:10.1007/s00216-023-04673-z. [PMID: 37017724 PMCID: PMC10074379 DOI: 10.1007/s00216-023-04673-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023]
Abstract
Human exhaled breath is becoming an attractive clinical source as it is foreseen to enable noninvasive diagnosis of many diseases. Because mask devices can be used for efficiently filtering exhaled substances, mask-wearing has been required in the past few years in daily life since the unprecedented COVID-19 pandemic. In recent years, there is a new development of mask devices as new wearable breath samplers for collecting exhaled substances for disease diagnosis and biomarker discovery. This paper attempts to identify new trends in mask samplers for breath analysis. The couplings of mask samplers with different (bio)analytical approaches, including mass spectrometry (MS), polymerase chain reaction (PCR), sensor, and others for breath analysis, are summarized. The developments and applications of mask samplers in disease diagnosis and human health are reviewed. The limitations and future trends of mask samplers are also discussed.
Collapse
Affiliation(s)
- Ximeng Liu
- Institute of Mass Spectrometry and Atmospheric Environment, Guangdong Provincial Engineering Research Center for On-Line Source Apportionment System of Air Pollution, Jinan University, Guangzhou, 510632, China
| | - Bin Hu
- Institute of Mass Spectrometry and Atmospheric Environment, Guangdong Provincial Engineering Research Center for On-Line Source Apportionment System of Air Pollution, Jinan University, Guangzhou, 510632, China.
| |
Collapse
|
6
|
Pan D, Williams CM, Decker J, Fletcher E, Sze S, Assadi S, Haigh R, Saleem B, Nazareth J, Garton NJ, Pareek M, Barer MR. Exhaled SARS-CoV-2 RNA viral load kinetics measured by facemask sampling associates with household transmission. Clin Microbiol Infect 2023; 29:254.e1-254.e6. [PMID: 35843566 PMCID: PMC9281452 DOI: 10.1016/j.cmi.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES No studies have examined longitudinal patterns of naturally exhaled SARS-CoV-2 RNA viral load (VL) during acute infection. We report this using facemask sampling (FMS) and assessed the relationship between emitted RNA VL and household transmission. METHODS Between December 2020 and February 2021, we recruited participants within 24 hours of a positive RT-qPCR on upper respiratory tract sampling (URTS) (day 0). Participants gave FMS (for 1 hour) and URTS (self-taken) on seven occasions up to day 21. Samples were analysed by RT-qPCR (from sampling matrix strips within the mask) and symptom diaries were recorded. Household transmission was assessed through reporting of positive URTS RT-qPCR in household contacts. RESULTS Analysis of 203 FMS and 190 URTS from 34 participants showed that RNA VL peaked within the first 5 days following sampling. Concomitant URTS, FMS RNA VL, and symptom scores, however, were poorly correlated, but a higher severity of reported symptoms was associated with FMS positivity up to day 5. Of 28 participants who had household contacts, 12 (43%) reported transmission. Frequency of household transmission was associated with the highest (peak) FMS RNA VL obtained (negative genome copies/strip: 0% household transmission; 1 to 1000 copies/strip: 20%; 1001 to 10 000 copies/strip: 57%; >10 000 copies/strip: 75%; p = 0.048; age adjusted OR of household transmission per log increase in copies/strip: 4.97; 95% CI, 1.20-20.55; p = 0.02) but not observed with peak URTS RNA VL. DISCUSSION Exhaled RNA VL measured by FMS is highest in early infection, can be positive in symptomatic patients with concomitantly negative URTS, and is strongly associated with household transmission.
Collapse
Affiliation(s)
- Daniel Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK; Li Ka Shing Center for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, UK.
| | - Caroline M Williams
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jonathan Decker
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Eve Fletcher
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Shirley Sze
- Department of Cardiovascular Sciences, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sara Assadi
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Richard Haigh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Baber Saleem
- Department of Engineering, University of Leicester, Leicester, UK
| | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Natalie J Garton
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Michael R Barer
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
7
|
Hu B. Recent Advances in Facemask Devices for In Vivo Sampling of Human Exhaled Breath Aerosols and Inhalable Environmental Exposures. Trends Analyt Chem 2022; 151:116600. [PMID: 35310778 PMCID: PMC8917876 DOI: 10.1016/j.trac.2022.116600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since the COVID-19 pandemic, the unprecedented use of facemasks has been requiring for wearing in daily life. By wearing facemask, human exhaled breath aerosols and inhaled environmental exposures can be efficiently filtered and thus various filtration residues can be deposited in facemask. Therefore, facemask could be a simple, wearable, in vivo, onsite and noninvasive sampler for collecting exhaled and inhalable compositions, and gain new insights into human health and environmental exposure. In this review, the recent advances in developments and applications of in vivo facemask sampling of human exhaled bacteria, viruses, proteins, and metabolites, and inhalable facemask contaminants and air pollutants, are reviewed. New features of facemask sampling are highlighted. The perspectives and challenges on further development and potential applications of facemask devices are also discussed.
Collapse
Affiliation(s)
- Bin Hu
- Institute of Mass Spectrometry and Atmospheric Environment, Guangdong Provincial Engineering Research Center for On-line Source Apportionment System of Air Pollution, Jinan University, Guangzhou 510632, China
| |
Collapse
|