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Tandjaoui-Lambiotte Y, Elabbadi A, Marouane B, Besset S, Roux D, Ebstein N, Pineau P, Marchio A, Bloch-Queyrat C, Lomont A, Alloui CA, Gerber A, Delagrèverie H, Cohen Y, Zahar JR, Voiriot G. Routes of SARS-Cov2 transmission in the intensive care unit: A multicentric prospective study. J Infect Public Health 2024; 17:102454. [PMID: 38936235 DOI: 10.1016/j.jiph.2024.05.042] [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] [Received: 10/07/2023] [Revised: 05/04/2024] [Accepted: 05/15/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The risk of SARS-CoV-2 transmission to health care workers in intensive care units (ICU) and the contribution of airborne and fomites to SARS-CoV-2 transmission remain unclear. To assess the rate of air and surface contamination and identify risk factors associated with this contamination in patients admitted to the ICU for acute respiratory failure due to SARS-CoV-2 pneumonia. METHODS Prospective multicentric non-interventional study conducted from June 2020 to November 2020 in 3 French ICUs. For each enrolled patient, 3 predefined surfaces were swabbed, 2 air samples at 1 m and 3 m from the patient's mouth and face masks of 3 health care workers (HCW) were collected within the first 48 h of SARS-CoV-2 positive PCR in a respiratory sample. Droplet digital PCR and quantitative PCR were performed on different samples, respectively. RESULTS Among 150 included patients, 5 (3.6%, 95%CI: 1.2% to 8.2%) had positive ddPCR on air samples at 1 m or 3 m. Seventy-one patients (53.3%, CI95%: 44.5% to 62.0%) had at least one surface positive. Face masks worn by HCW were positive in 6 patients (4.4%, CI: 1.6% to 9.4%). The threshold of RT-qPCR of the respiratory sample performed at inclusion (odds ratio, OR= 0.88, 95%CI: 0.83 to 0.93, p < 0.0001) and the presence of diarrhea (OR= 3.28, 95%CI: 1.09 to 9.88, p = 0.037) were significantly associated with the number of contaminated surfaces. CONCLUSION In this study, including patients admitted to the ICU for acute respiratory failure " contact route " of transmission, i.e. through fomites, seems dominant. While presence of SARS-CoV-2 in the air is rare in this specific population, the presence of diarrhea is associated to surface contamination around Covid patients.
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Affiliation(s)
- Yacine Tandjaoui-Lambiotte
- Delafontaine Hospital, Department of Pulmonology and Infectious Diseases, Saint Denis, France; INSERM UMR 1272 Hypoxia & Lung, Bobigny, France; INSERM UMR 1137 IAME, Paris, France.
| | - Alexandre Elabbadi
- Sorbonne Université, Centre de Recherche Saint-Antoine UMRS_938 INSERM, Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Boubaya Marouane
- University Sorbonne Paris Nord, APHP, Avicenne hospital, Clinical Research Unit, Bobigny, France
| | - Sebastien Besset
- University Paris Cité, APHP, Louis Mourier Hospital, DMU ESPRIT, Intensive Care Unit, Colombes, France
| | - Damien Roux
- University Paris Cité, APHP, Louis Mourier Hospital, DMU ESPRIT, Intensive Care Unit, Colombes, France
| | - Nathan Ebstein
- University Sorbonne Paris Nord, APHP, Avicenne Hospital, Intensive Care Unit, Bobigny, France
| | - Pascal Pineau
- Pasteur Institute, Nuclear organization and oncogenesis, INSERM U993, France
| | - Agnes Marchio
- Pasteur Institute, Nuclear organization and oncogenesis, INSERM U993, France
| | - Coralie Bloch-Queyrat
- University Sorbonne Paris Nord, APHP, Avicenne hospital, Clinical Research Unit, Bobigny, France
| | - Alexandra Lomont
- University Sorbonne Paris Nord, APHP, Avicenne Hospital, Microbiology Department, Infection Control Unit, Bobigny, France Sorbonne Paris Nord University, Bobigny, France
| | - Chakib-Ahmed Alloui
- University Sorbonne Paris Nord, APHP, Avicenne Hospital, Microbiology Department Virology Unit, Bobigny, France, Sorbonne Paris Nord University, Bobigny, France
| | - Athenaïs Gerber
- University Sorbonne Paris Nord, APHP, Avicenne Hospital, Microbiology Department Virology Unit, Bobigny, France, Sorbonne Paris Nord University, Bobigny, France
| | - Heloise Delagrèverie
- University Sorbonne Paris Nord, APHP, Avicenne Hospital, Microbiology Department Virology Unit, Bobigny, France, Sorbonne Paris Nord University, Bobigny, France
| | - Yves Cohen
- University Sorbonne Paris Nord, APHP, Avicenne Hospital, Intensive Care Unit, Bobigny, France
| | - Jean Ralph Zahar
- University Paris Cité, APHP, Louis Mourier Hospital, DMU ESPRIT, Intensive Care Unit, Colombes, France
| | - Guillaume Voiriot
- Sorbonne Université, Centre de Recherche Saint-Antoine UMRS_938 INSERM, Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
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Fijan S, Kürti P, Rozman U, Šostar Turk S. A critical assessment of microbial-based antimicrobial sanitizing of inanimate surfaces in healthcare settings. Front Microbiol 2024; 15:1412269. [PMID: 38933019 PMCID: PMC11199901 DOI: 10.3389/fmicb.2024.1412269] [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: 04/04/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
The global rise in antimicrobial resistance (AMR) poses a significant public health threat, especially in healthcare settings, where controlling the spread of antimicrobial genes is crucial. While person-to-person transmission remains the primary route for healthcare-associated infections (HAIs), hospital surfaces serve as key reservoirs for antimicrobial-resistant microorganisms. Regular cleaning and disinfection of these surfaces are essential. Microbial-based products for sanitizing hospital surfaces have emerged as promising tools to combat HAIs and AMR. However, a review of 32 publications found inconsistencies and potential risks. A total of 15 publications included hospital-based trials, while the rest were either in vitro or in situ assays, reviews, book chapters, or commentaries. In most of the hospital-based studies, specific strains of applied microorganisms were not identified, and the term "probiotic" was inaccurately used. These products mainly featured spores from Bacillus and Priestia genera, which was mainly hypothesized to work through competitive exclusion. Most hospital-based studies have shown that the application of microbial-based products resulted in a significant reduction in pathogens on surfaces, thereby contributing to a decrease in the incidence of healthcare-associated infections (HAIs). Further research is however needed to understand the effectiveness, mechanisms of action, and safety of microbial-based sanitizing agents. Strain-level identification is crucial for safety assessments, yet many reviewed products lacked this information. Consequently, there is a need for rigorous safety evaluations within existing regulatory frameworks to ensure the efficacy and safety of microbial-based cleaning products in healthcare settings.
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Affiliation(s)
- Sabina Fijan
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | | | - Urška Rozman
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Sonja Šostar Turk
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
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Kumar DS, Prasanth K, Bhandari A, Kumar Jha V, Naveen A, Prasanna M. Innovations and Challenges in the Development of COVID-19 Vaccines for a Safer Tomorrow. Cureus 2024; 16:e60015. [PMID: 38854201 PMCID: PMC11162516 DOI: 10.7759/cureus.60015] [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] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Vaccination, a historically effective public health intervention, has shielded millions from various diseases. Lessons from severe acute respiratory syndrome coronavirus (SARS-CoV) have improved COVID-19 vaccine development. Despite mRNA vaccines' efficacy, emerging variants pose challenges, exhibiting increased transmissibility, infectivity, and severity. Developing COVID-19 vaccines has faced hurdles due to urgency, limited virus understanding, and the need for safe solutions. Genetic variability necessitates continuous vaccine adjustments and production challenges demand scaling up manufacturing with stringent quality control. This review explores SARS-CoV-2's evolution, upcoming mutations that challenge vaccines, and strategies such as structure-based, T cell-based, respiratory mucosal-based, and nanotechnology approaches for vaccine development. This review insight provides a roadmap for navigating virus evolution and improving vaccine development.
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Affiliation(s)
- Devika S Kumar
- Research, Panimalar Medical College Hospital and Research Institute, Chennai, IND
| | - Krishna Prasanth
- Department of Community Medicine, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Ashni Bhandari
- Department of Community Medicine, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Vivek Kumar Jha
- Department of Audiology and Speech Language Pathology, Shree Guru Gobind Singh Tricentenary (SGT) University, Haryana, IND
| | - Avula Naveen
- Pharmacology and Therapeutics, All India Institute Of Medical Science Bilaspur, Bilaspur, IND
| | - Muthu Prasanna
- Pharmaceutics, Pharmaceutical Biotechnology, Surya School of Pharmacy, Surya Group of Institutions, Villupuram, IND
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Wilson NM, Calabria C, Warren A, Finlay A, O'Donovan A, Passerello GL, Ribaric NL, Ward P, Gillespie R, Farrel R, McNarry AF, Pan D. Quantifying hospital environmental ventilation using carbon dioxide monitoring - a multicentre study. Anaesthesia 2024; 79:147-155. [PMID: 38059394 DOI: 10.1111/anae.16124] [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] [Accepted: 08/17/2023] [Indexed: 12/08/2023]
Abstract
The COVID-19 pandemic has highlighted the importance of environmental ventilation in reducing airborne pathogen transmission. Carbon dioxide monitoring is recommended in the community to ensure adequate ventilation. Dynamic measurements of ventilation quantifying human exhaled waste gas accumulation are not conducted routinely in hospitals. Instead, environmental ventilation is allocated using static hourly air change rates. These vary according to the degree of perceived hazard, with the highest change rates reserved for locations where aerosol-generating procedures are performed, where medical/anaesthetic gases are used and where a small number of high-risk infective or immunocompromised patients may be isolated to reduce cross-infection. We aimed to quantify the quality and distribution of ventilation in hospital by measuring carbon dioxide levels in a two-phased prospective observational study. First, under controlled conditions, we validated our method and the relationship between human occupancy, ventilation and carbon dioxide levels using non-dispersive infrared carbon dioxide monitors. We then assessed ventilation quality in patient-occupied (clinical) and staff break and office (non-clinical) areas across two hospitals in Scotland. We selected acute medical and respiratory wards in which patients with COVID-19 are cared for routinely, as well as ICUs and operating theatres where aerosol-generating procedures are performed routinely. Between November and December 2022, 127,680 carbon dioxide measurements were obtained across 32 areas over 8 weeks. Carbon dioxide levels breached the 800 ppm threshold for 14% of the time in non-clinical areas vs. 7% in clinical areas (p < 0.001). In non-clinical areas, carbon dioxide levels were > 800 ppm for 20% of the time in both ICUs and wards, vs. 1% in operating theatres (p < 0.001). In clinical areas, carbon dioxide was > 800 ppm for 16% of the time in wards, vs. 0% in ICUs and operating theatres (p < 0.001). We conclude that staff break, office and clinical areas on acute medical and respiratory wards frequently had inadequate ventilation, potentially increasing the risks of airborne pathogen transmission to staff and patients. Conversely, ventilation was consistently high in the ICU and operating theatre clinical environments. Carbon dioxide monitoring could be used to measure and guide improvements in hospital ventilation.
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Affiliation(s)
- N M Wilson
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Calabria
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Warren
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Finlay
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - A O'Donovan
- Department of Process, Energy and Transport Engineering, MeSSO Research Group, Munster Technological University, Cork, Ireland
| | - G L Passerello
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - N L Ribaric
- Faculty of Medicine, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - P Ward
- Department of Anaesthesia, St John's Hospital, Livingston, UK
| | - R Gillespie
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R Farrel
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - A F McNarry
- Department of Anaesthesia, Western General Hospital, UK
| | - D 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
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5
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Berlet M, Fuchtmann J, Krumpholz R, Naceri A, Macari D, Jähne-Schon C, Haddadin S, Friess H, Feussner H, Wilhelm D. Toward telemedical diagnostics-clinical evaluation of a robotic examination system for emergency patients. Digit Health 2024; 10:20552076231225084. [PMID: 38205033 PMCID: PMC10777806 DOI: 10.1177/20552076231225084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction The SARS-CoV-2 pandemic has affected global public healthcare for several years. Numerous medical professionals have been infected since the outbreak in 2019, resulting in a shortage of healthcare providers. Since traditional personal protective wear was insufficient to eliminate the virus transmission reliably, new strategies to avoid cross-infection were imperative while enabling high-quality medical care. In the project ProteCT, we investigated the potential of robotic-assisted examination in providing medical examination via a telemedical approach. Material and Methods We constructed a fully functional examination cabin equipped with cameras, microphones, screens and robotic arms to evaluate usability and perception. Therefore, we conducted a preliminary study with 10 healthy volunteers and 10 physicians to gain first insights and optimize the setup. In a second step, we performed telemedical examinations of actual patients from the local emergency department to compare the robotic approach with the classical method of measuring vital signs, auscultation, palpation and percussion. Results The preliminary study identified basic requirements, such as the need for force-feedback and telemedical training for physicians. In the main study, acceptance was high and most patients indicated they would use a telemedical system again. Our setup enabled the physician to make the same diagnoses as by classic examination in the emergency department in most cases. Discussion The potential acceptance of a telemedical system such as ProteCT is high. Robotic telemedical approaches could complement future healthcare beyond the Corona pandemic to reach rural areas or even war zones. Moreover, the daily clinical use of robotic telemedicine could improve patients' safety, the quality of perioperative management and the workflow in any medical facility. Conclusion The development of telemedical and telerobotic systems is a multidisciplinary and complex challenge. However, acceptance of the proposed system was high among patients and physicians, indicating the potential use of similar systems for future healthcare.
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Affiliation(s)
- Maximilian Berlet
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jonas Fuchtmann
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roman Krumpholz
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Abdeldjallil Naceri
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich, Munich, Germany
| | - Daniela Macari
- Franka Emika GmbH, Munich, Germany
- Max Planck Institute for Intelligent Systems, Max Planck ETH Center for Learning Systems, Stuttgart, Germany
| | | | - Sami Haddadin
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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6
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Terning G, El-Thalji I, Brun EC. The Impact of Patient Infection Rate on Emergency Department Patient Flow: Hybrid Simulation Study in a Norwegian Case. Healthcare (Basel) 2023; 11:1904. [PMID: 37444740 DOI: 10.3390/healthcare11131904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
The COVID-19 pandemic put emergency departments all over the world under severe and unprecedented distress. Previous methods of evaluating patient flow impact, such as in-situ simulation, tabletop studies, etc., in a rapidly evolving pandemic are prohibitively impractical, time-consuming, costly, and inflexible. For instance, it is challenging to study the patient flow in the emergency department under different infection rates and get insights using in-situ simulation and tabletop studies. Despite circumventing many of these challenges, the simulation modeling approach and hybrid agent-based modeling stand underutilized. This study investigates the impact of increased patient infection rate on the emergency department patient flow by using a developed hybrid agent-based simulation model. This study reports findings on the patient infection rate in different emergency department patient flow configurations. This study's results quantify and demonstrate that an increase in patient infection rate will lead to an incremental deterioration of the patient flow metrics average length of stay and crowding within the emergency department, especially if the waiting functions are introduced. Along with other findings, it is concluded that waiting functions, including the waiting zone, make the single average length of stay an ineffective measure as it creates a multinomial distribution of several tendencies.
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Affiliation(s)
- Gaute Terning
- Department of Safety, Economics, and Planning, University of Stavanger, 4036 Stavanger, Norway
| | - Idriss El-Thalji
- Department of Mechanical and Structural Engineering and Materials Science, University of Stavanger, 4036 Stavanger, Norway
| | - Eric Christian Brun
- Department of Safety, Economics, and Planning, University of Stavanger, 4036 Stavanger, Norway
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7
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Rodriguez-Rodriguez BA, Ciabattoni GO, Duerr R, Valero-Jimenez AM, Yeung ST, Crosse KM, Schinlever AR, Bernard-Raichon L, Rodriguez Galvan J, McGrath ME, Vashee S, Xue Y, Loomis CA, Khanna KM, Cadwell K, Desvignes L, Frieman MB, Ortigoza MB, Dittmann M. A neonatal mouse model characterizes transmissibility of SARS-CoV-2 variants and reveals a role for ORF8. Nat Commun 2023; 14:3026. [PMID: 37230979 PMCID: PMC10211296 DOI: 10.1038/s41467-023-38783-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
Small animal models have been a challenge for the study of SARS-CoV-2 transmission, with most investigators using golden hamsters or ferrets. Mice have the advantages of low cost, wide availability, less regulatory and husbandry challenges, and the existence of a versatile reagent and genetic toolbox. However, adult mice do not robustly transmit SARS-CoV-2. Here we establish a model based on neonatal mice that allows for transmission of clinical SARS-CoV-2 isolates. We characterize tropism, respiratory tract replication and transmission of ancestral WA-1 compared to variants Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Delta (B.1.617.2), Omicron BA.1 and Omicron BQ.1.1. We identify inter-variant differences in timing and magnitude of infectious particle shedding from index mice, both of which shape transmission to contact mice. Furthermore, we characterize two recombinant SARS-CoV-2 lacking either the ORF6 or ORF8 host antagonists. The removal of ORF8 shifts viral replication towards the lower respiratory tract, resulting in significantly delayed and reduced transmission in our model. Our results demonstrate the potential of our neonatal mouse model to characterize viral and host determinants of SARS-CoV-2 transmission, while revealing a role for an accessory protein in this context.
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Affiliation(s)
| | - Grace O Ciabattoni
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Ralf Duerr
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Department of Medicine/Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Vaccine Center, NYU Grossmann of Medicine, New York, NY, 10016, USA
| | - Ana M Valero-Jimenez
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Stephen T Yeung
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Keaton M Crosse
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Austin R Schinlever
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Lucie Bernard-Raichon
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Joaquin Rodriguez Galvan
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Marisa E McGrath
- Department of Microbiology and Immunology, Center for Pathogen Research, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Sanjay Vashee
- Department of Synthetic Biology and Bioenergy, J. Craig Venter Institute, Rockville, MD, 20850, USA
| | - Yong Xue
- Department of Synthetic Biology and Bioenergy, J. Craig Venter Institute, Rockville, MD, 20850, USA
| | - Cynthia A Loomis
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Kamal M Khanna
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Perlmutter Cancer Center, New York University Langone Health, New York, NY, 10016, USA
| | - Ken Cadwell
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Ludovic Desvignes
- Department of Medicine/Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY, 10016, USA
- High Containment Laboratories - Office of Science and Research, NYU Langone Health, New York, NY, 10016, USA
| | - Matthew B Frieman
- Department of Microbiology and Immunology, Center for Pathogen Research, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Mila B Ortigoza
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, 10016, USA.
- Department of Medicine/Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY, 10016, USA.
| | - Meike Dittmann
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, 10016, USA.
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Mardiko AA, Buer J, Köster AM, Kaba HEJ, Mattner F, Zweigner J, Mutters NT, von Maltzahn N, Leistner R, Eckmanns T, Brandt C, Scheithauer S. Infection Prevention and Control between Legal Requirements and "German Society for Hygiene and Microbiology" Expert Assessments: A Cross-Sectional Study in September-November 2022. J Hosp Infect 2023:S0195-6701(23)00112-3. [PMID: 37061047 PMCID: PMC10101543 DOI: 10.1016/j.jhin.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/15/2023] [Accepted: 04/03/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND In contrast to the beginning of the SARS-CoV-2 pandemic, more and more hospital issues are regulated by policy. AIM To identify differences between experts' recommendations and legal requirements regarding infection prevention and control (IPC) strategies. METHODS A cross-sectional study was conducted between 2022/09/29 - 2022/11/03 addressing 1319 members of the German Society for Hygiene and Microbiology (DGHM), the response rate was 12%. Reported here are the expert's recommendations on different IPC strategies. FINDINGS The majority (66%) of experts would recommend universal mask usage, with 34% recommending it seasonally, even after the SARS-CoV-2 pandemic. The medical microbiologists (MM) were more likely to recommend continuing to wear the masks indefinitely than IPC experts. Concerning the mask type, medical masks were recommended more frequently by IPC experts (47.3%), while FFP2 masks were more preferred by MM (31.8%). The majority (54.7%) would advise universal screening of employees, mainly in settings with extremely vulnerable patients and if the regional incidences were high, at a frequency of twice a week. With at least 50%, the dominant advice for employees being exposed to SARS-CoV-2 was working with daily testing and wearing a mask, regardless of the length of exposure. CONCLUSIONS The expert recommendations deviate from the legal situation and appear to be more differentiated and proportional. The influence of specific experience and expertise on the mask recommendation should be investigated in more detail. For relevant policy decisions, a quick, focused, and broad-based consultation of expertise could be of added value.
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Affiliation(s)
- Amelia A Mardiko
- Affiliations (1)Department of Infection Control and Infectious Diseases, University Medical Centre Göttingen, Germany
| | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - A Milena Köster
- Affiliations (1)Department of Infection Control and Infectious Diseases, University Medical Centre Göttingen, Germany
| | - Hani E J Kaba
- Affiliations (1)Department of Infection Control and Infectious Diseases, University Medical Centre Göttingen, Germany
| | - Frauke Mattner
- Institute for Hygiene, Cologne Merheim Medical Centre, University Witten-Herdecke, Germany
| | - Janine Zweigner
- Department of Infection Control and Hospital Hygiene, University Hospital Cologne, Germany
| | - Nico T Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Germany
| | - Nicole von Maltzahn
- Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hanover, Germany
| | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany; Division of Gastroenterology, Infectious Diseases and Rheumatology, Medical Department, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Tim Eckmanns
- Division of Nosocomial Infection, surveillance of antibiotic Resistance and Consumption, the Robert Koch Institute. Germany
| | - Christian Brandt
- Section for Hospital and Environmental Hygiene, Centre for Infectious Diseases, Heidelberg University Hospital, Germany
| | - Simone Scheithauer
- Affiliations (1)Department of Infection Control and Infectious Diseases, University Medical Centre Göttingen, Germany.
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Groma V, Kugler S, Farkas Á, Füri P, Madas B, Nagy A, Erdélyi T, Horváth A, Müller V, Szántó-Egész R, Micsinai A, Gálffy G, Osán J. Size distribution and relationship of airborne SARS-CoV-2 RNA to indoor aerosol in hospital ward environments. Sci Rep 2023; 13:3566. [PMID: 36864124 PMCID: PMC9980870 DOI: 10.1038/s41598-023-30702-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/28/2023] [Indexed: 03/04/2023] Open
Abstract
Aerosol particles proved to play a key role in airborne transmission of SARS-CoV-2 viruses. Therefore, their size-fractionated collection and analysis is invaluable. However, aerosol sampling in COVID departments is not straightforward, especially in the sub-500-nm size range. In this study, particle number concentrations were measured with high temporal resolution using an optical particle counter, and several 8 h daytime sample sets were collected simultaneously on gelatin filters with cascade impactors in two different hospital wards during both alpha and delta variants of concern periods. Due to the large number (152) of size-fractionated samples, SARS-CoV-2 RNA copies could be statistically analyzed over a wide range of aerosol particle diameters (70-10 µm). Our results revealed that SARS-CoV-2 RNA is most likely to exist in particles with 0.5-4 µm aerodynamic diameter, but also in ultrafine particles. Correlation analysis of particulate matter (PM) and RNA copies highlighted the importance of indoor medical activity. It was found that the daily maximum increment of PM mass concentration correlated the most with the number concentration of SARS-CoV-2 RNA in the corresponding size fractions. Our results suggest that particle resuspension from surrounding surfaces is an important source of SARS-CoV-2 RNA present in the air of hospital rooms.
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Affiliation(s)
- V Groma
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - Sz Kugler
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - Á Farkas
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - P Füri
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - B Madas
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - A Nagy
- Department of Applied and Nonlinear Optics, Wigner Research Centre for Physics, Budapest, 1121, Hungary
| | - T Erdélyi
- Department of Pulmonology, Semmelweis University, Budapest, 1085, Hungary
| | - A Horváth
- Department of Pulmonology, Semmelweis University, Budapest, 1085, Hungary
- Pest County Pulmonology Hospital, Törökbálint, 2045, Hungary
| | - V Müller
- Department of Pulmonology, Semmelweis University, Budapest, 1085, Hungary
| | | | | | - G Gálffy
- Pest County Pulmonology Hospital, Törökbálint, 2045, Hungary
| | - J Osán
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary.
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10
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Tandjaoui-Lambiotte Y, Lomont A, Moenne-Locoz P, Seytre D, Zahar JR. Spread of viruses, which measures are the most apt to control COVID-19? Infect Dis Now 2023; 53:104637. [PMID: 36526247 PMCID: PMC9746078 DOI: 10.1016/j.idnow.2022.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
The persistent debate about the modes of transmission of SARS-CoV2 and preventive measures has illustrated the limits of our knowledge regarding the measures to be implemented in the face of viral risk. Past and present (pandemic-related) scientific data underline the complexity of the phenomenon and its variability over time. Several factors contribute to the risk of transmission, starting with incidence in the general population (i.e., colonization pressure) and herd immunity. Other major factors include intensity of symptoms, interactions with the reservoir (proximity and duration of contact), the specific characteristics of the virus(es) involved, and a number of unpredictable elements (humidity, temperature, ventilation…). In this review, we will emphasize the difficulty of "standardizing" the situations that might explain the discrepancies found in the literature. We will show that the airborne route remains the main mode of transmission. Regarding preventive measures of prevention, while vaccination remains the cornerstone of the fight against viral outbreaks, we will remind the reader that wearing a mask is the main barrier measure and that the choice of type of mask depends on the risk situations. Finally, we believe that the recent pandemic should induce us in the future to modify our recommendations by adapting our measures in hospitals, not to the pathogen concerned, which is currently the case, but rather to the type of at-risk situation.
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Affiliation(s)
- Y Tandjaoui-Lambiotte
- Service de Pneumologie-Infectiologie, CH Saint Denis, 2 rue Dr. Delafontaine, 93200, France
| | - A Lomont
- Unité de Prévention du Risque Infectieux, Service de microbiologie clinique, GHU Paris Seine Saint-Denis, Université Sorbonne Paris Nord, France
| | - P Moenne-Locoz
- Unité de Prévention du Risque Infectieux, Service de microbiologie clinique, GHU Paris Seine Saint-Denis, Université Sorbonne Paris Nord, France
| | - D Seytre
- Unité de Prévention du Risque Infectieux, Service de microbiologie clinique, GHU Paris Seine Saint-Denis, Université Sorbonne Paris Nord, France
| | - J R Zahar
- Unité de Prévention du Risque Infectieux, Service de microbiologie clinique, GHU Paris Seine Saint-Denis, Université Sorbonne Paris Nord, France.
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11
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Yang YF, Lin YJ, You SH, Lu TH, Chen CY, Wang WM, Liao CM. Control measure implications of COVID-19 infection in healthcare facilities reconsidered from human physiological and engineering aspects. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:36228-36243. [PMID: 36547825 PMCID: PMC9772602 DOI: 10.1007/s11356-022-24815-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
The Wells-Riley model invokes human physiological and engineering parameters to successfully treat airborne transmission of infectious diseases. Applications of this model would have high potentiality on evaluating policy actions and interventions intended to improve public safety efforts on preventing the spread of COVID-19 in an enclosed space. Here, we constructed the interaction relationships among basic reproduction number (R0) - exposure time - indoor population number by using the Wells-Riley model to provide a robust means to assist in planning containment efforts. We quantified SARS-CoV-2 changes in a case study of two Wuhan (Fangcang and Renmin) hospitals. We conducted similar approach to develop control measures in various hospital functional units by taking all accountable factors. We showed that inhalation rates of individuals proved crucial for influencing the transmissibility of SARS-CoV-2, followed by air supply rate and exposure time. We suggest a minimum air change per hour (ACH) of 7 h-1 would be at least appropriate with current room volume requirements in healthcare buildings when indoor population number is < 10 and exposure time is < 1 h with one infector and low activity levels being considered. However, higher ACH (> 16 h-1) with optimal arranged-exposure time/people and high-efficiency air filters would be suggested if more infectors or higher activity levels are presented. Our models lay out a practical metric for evaluating the efficacy of control measures on COVID-19 infection in built environments. Our case studies further indicate that the Wells-Riley model provides a predictive and mechanistic basis for empirical COVID-19 impact reduction planning and gives a framework to treat highly transmissible but mechanically heterogeneous airborne SARS-CoV-2.
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Affiliation(s)
- Ying-Fei Yang
- Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, 10617, Taiwan
| | - Yi-Jun Lin
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chia Tung University, Taipei, 11221, Taiwan
| | - Shu-Han You
- Institute of Food Safety and Risk Management, National Taiwan Ocean University, Keelung City, 20224, Taiwan
| | - Tien-Hsuan Lu
- Department of Environmental Engineering, Da-Yeh University, Changhua, 515006, Taiwan
| | - Chi-Yun Chen
- Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, 10617, Taiwan
| | - Wei-Min Wang
- Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, 10617, Taiwan
| | - Chung-Min Liao
- Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, 10617, Taiwan.
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12
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Oksanen LAH, Virtanen J, Sanmark E, Rantanen N, Venkat V, Sofieva S, Aaltonen K, Kivistö I, Svirskaite J, Pérez AD, Kuula J, Levanov L, Hyvärinen A, Maunula L, Atanasova NS, Laitinen S, Anttila V, Lehtonen L, Lappalainen M, Geneid A, Sironen T. SARS-CoV-2 indoor environment contamination with epidemiological and experimental investigations. INDOOR AIR 2022; 32:e13118. [PMID: 36305066 PMCID: PMC9828560 DOI: 10.1111/ina.13118] [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: 05/14/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 05/02/2023]
Abstract
SARS-CoV-2 has been detected both in air and on surfaces, but questions remain about the patient-specific and environmental factors affecting virus transmission. Additionally, more detailed information on viral sampling of the air is needed. This prospective cohort study (N = 56) presents results from 258 air and 252 surface samples from the surroundings of 23 hospitalized and eight home-treated COVID-19 index patients between July 2020 and March 2021 and compares the results between the measured environments and patient factors. Additionally, epidemiological and experimental investigations were performed. The proportions of qRT-PCR-positive air (10.7% hospital/17.6% homes) and surface samples (8.8%/12.9%) showed statistical similarity in hospital and homes. Significant SARS-CoV-2 air contamination was observed in a large (655.25 m3 ) mechanically ventilated (1.67 air changes per hour, 32.4-421 L/s/patient) patient hall even with only two patients present. All positive air samples were obtained in the absence of aerosol-generating procedures. In four cases, positive environmental samples were detected after the patients had developed a neutralizing IgG response. SARS-CoV-2 RNA was detected in the following particle sizes: 0.65-4.7 μm, 7.0-12.0 μm, >10 μm, and <100 μm. Appropriate infection control against airborne and surface transmission routes is needed in both environments, even after antibody production has begun.
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Affiliation(s)
- Lotta‐Maria A. H. Oksanen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics – Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
| | - Jenni Virtanen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Enni Sanmark
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics – Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
| | - Noora Rantanen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics – Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
| | - Vinaya Venkat
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Svetlana Sofieva
- Faculty of Biological and Environmental SciencesUniversity of HelsinkiHelsinkiFinland
- Finnish Meteorological InstituteHelsinkiFinland
| | - Kirsi Aaltonen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Ilkka Kivistö
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Julija Svirskaite
- Faculty of Biological and Environmental SciencesUniversity of HelsinkiHelsinkiFinland
| | | | - Joel Kuula
- Finnish Meteorological InstituteHelsinkiFinland
| | - Lev Levanov
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | | | - Leena Maunula
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Nina S. Atanasova
- Faculty of Biological and Environmental SciencesUniversity of HelsinkiHelsinkiFinland
- Finnish Meteorological InstituteHelsinkiFinland
| | | | - Veli‐Jukka Anttila
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- HUS Inflammation CenterHelsinki University HospitalHelsinkiFinland
| | - Lasse Lehtonen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- HUS Diagnostic Center, HUSLABHelsinki University HospitalHelsinkiFinland
| | - Maija Lappalainen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- HUS Diagnostic Center, HUSLABHelsinki University HospitalHelsinkiFinland
| | - Ahmed Geneid
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics – Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
| | - Tarja Sironen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
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13
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Viral Cultures for Assessing Fomite Transmission of SARS-CoV-2: a Systematic Review and Meta-Analysis. J Hosp Infect 2022; 130:63-94. [PMID: 36115620 PMCID: PMC9473144 DOI: 10.1016/j.jhin.2022.09.007] [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: 08/01/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 01/01/2023]
Abstract
Background The role of fomites in the transmission of SARS-CoV-2 is unclear. Aim To assess whether SARS-CoV-2 can be transmitted through fomites, using evidence from viral culture studies. Methods Searches were conducted in the World Health Organization COVID-19 Database, PubMed, LitCovid, medRxiv, and Google Scholar to December 31st, 2021. Studies that investigated fomite transmission and performed viral culture to assess the cytopathic effect (CPE) of positive fomite samples and confirmation of SARS-CoV-2 as the cause of the CPE were included. The risk of bias using a checklist modified from the modified Quality Assessment of Diagnostic Accuracy Studies – 2 (QUADAS-2) criteria was assessed. Findings Twenty-three studies were included. The overall risk of bias was moderate. Five studies demonstrated replication-competent virus from fomite cultures and three used genome sequencing to match fomite samples with human clinical specimens. The mean cycle threshold (CT) of samples with positive viral culture was significantly lower compared with cultured samples that returned negative results (standardized mean difference: –1.45; 95% confidence interval (CI): –2.00 to –0.90; I2 = 0%; P < 0.00001). The likelihood of isolating replication-competent virus was significantly greater when CT was <30 (relative risk: 3.10; 95% CI: 1.32 to 7.31; I2 = 71%; P = 0.01). Infectious specimens were mostly detected within seven days of symptom onset. One study showed possible transmission of SARS-CoV-2 from fomites to humans. Conclusion The evidence from published studies suggests that replication-competent SARS-CoV-2 is present on fomites. Replication-competent SARS-CoV-2 is significantly more likely when the PCR CT for clinical specimens and fomite samples is <30. Further studies should investigate the duration of infectiousness of SARS-CoV-2 and the frequency of transmission from fomites.
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14
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Duval D, Palmer JC, Tudge I, Pearce-Smith N, O'Connell E, Bennett A, Clark R. Long distance airborne transmission of SARS-CoV-2: rapid systematic review. BMJ 2022; 377:e068743. [PMID: 35768139 PMCID: PMC9240778 DOI: 10.1136/bmj-2021-068743] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate the potential for long distance airborne transmission of SARS-CoV-2 in indoor community settings and to investigate factors that might influence transmission. DESIGN Rapid systematic review and narrative synthesis. DATA SOURCES Medline, Embase, medRxiv, Arxiv, and WHO COVID-19 Research Database for studies published from 27 July 2020 to 19 January 2022; existing relevant rapid systematic review for studies published from 1 January 2020 to 27 July 2020; and citation analysis in Web of Science and Cocites. ELIGIBILITY CRITERIA FOR STUDY SELECTION Observational studies reporting on transmission events in indoor community (non-healthcare) settings in which long distance airborne transmission of SARS-CoV-2 was the most likely route. Studies such as those of household transmission where the main transmission route was likely to be close contact or fomite transmission were excluded. DATA EXTRACTION AND SYNTHESIS Data extraction was done by one reviewer and independently checked by a second reviewer. Primary outcomes were SARS-CoV-2 infections through long distance airborne transmission (>2 m) and any modifying factors. Methodological quality of included studies was rated using the quality criteria checklist, and certainty of primary outcomes was determined using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Narrative synthesis was themed by setting. RESULTS 22 reports relating to 18 studies were identified (methodological quality was high in three, medium in five, and low in 10); all the studies were outbreak investigations. Long distance airborne transmission was likely to have occurred for some or all transmission events in 16 studies and was unclear in two studies (GRADE: very low certainty). In the 16 studies, one or more factors plausibly increased the likelihood of long distance airborne transmission, particularly insufficient air replacement (very low certainty), directional air flow (very low certainty), and activities associated with increased emission of aerosols, such as singing or speaking loudly (very low certainty). In 13 studies, the primary cases were reported as being asymptomatic, presymptomatic, or around symptom onset at the time of transmission. Although some of the included studies were well conducted outbreak investigations, they remain at risk of bias owing to study design and do not always provide the level of detail needed to fully assess transmission routes. CONCLUSION This rapid systematic review found evidence suggesting that long distance airborne transmission of SARS-CoV-2 might occur in indoor settings such as restaurants, workplaces, and venues for choirs, and identified factors such as insufficient air replacement that probably contributed to transmission. These results strengthen the need for mitigation measures in indoor settings, particularly the use of adequate ventilation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021236762.
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Affiliation(s)
- Daphne Duval
- COVID-19 Rapid Evidence Service, UK Health Security Agency, London, UK
| | - Jennifer C Palmer
- COVID-19 Rapid Evidence Service, UK Health Security Agency, London, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Isobel Tudge
- COVID-19 Rapid Evidence Service, UK Health Security Agency, London, UK
| | | | - Emer O'Connell
- COVID-19 Advice and Guidance, UK Health Security Agency, London, UK
| | - Allan Bennett
- Biosafety, Air, and Water Microbiology Group, Research and Evaluation, UK Health Security Agency, Porton, UK
| | - Rachel Clark
- COVID-19 Rapid Evidence Service, UK Health Security Agency, London, UK
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15
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Kvasnicka J, Cohen Hubal EA, Siegel JA, Scott JA, Diamond ML. Modeling Clothing as a Vector for Transporting Airborne Particles and Pathogens across Indoor Microenvironments. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:5641-5652. [PMID: 35404579 PMCID: PMC9069698 DOI: 10.1021/acs.est.1c08342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
Evidence suggests that human exposure to airborne particles and associated contaminants, including respiratory pathogens, can persist beyond a single microenvironment. By accumulating such contaminants from air, clothing may function as a transport vector and source of "secondary exposure". To investigate this function, a novel microenvironmental exposure modeling framework (ABICAM) was developed. This framework was applied to a para-occupational exposure scenario involving the deposition of viable SARS-CoV-2 in respiratory particles (0.5-20 μm) from a primary source onto clothing in a nonhealthcare setting and subsequent resuspension and secondary exposure in a car and home. Variability was assessed through Monte Carlo simulations. The total volume of infectious particles on the occupant's clothing immediately after work was 4800 μm3 (5th-95th percentiles: 870-32 000 μm3). This value was 61% (5-95%: 17-300%) of the occupant's primary inhalation exposure in the workplace while unmasked. By arrival at the occupant's home after a car commute, relatively rapid viral inactivation on cotton clothing had reduced the infectious volume on clothing by 80% (5-95%: 26-99%). Secondary inhalation exposure (after work) was low in the absence of close proximity and physical contact with contaminated clothing. In comparison, the average primary inhalation exposure in the workplace was higher by about 2-3 orders of magnitude. It remains theoretically possible that resuspension and physical contact with contaminated clothing can occasionally transmit SARS-CoV-2 between humans.
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Affiliation(s)
- Jacob Kvasnicka
- Department
of Earth Sciences, University of Toronto, Toronto, Ontario M5S 3B1, Canada
| | - Elaine A. Cohen Hubal
- Center
for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Durham, North Carolina 27711, United States
| | - Jeffrey A. Siegel
- Department
of Civil and Mineral Engineering, University
of Toronto, Toronto, Ontario M5S 1A4, Canada
- Dalla
Lana School of Public Health, University
of Toronto, Toronto, Ontario M5T 3M7, Canada
| | - James A. Scott
- Dalla
Lana School of Public Health, University
of Toronto, Toronto, Ontario M5T 3M7, Canada
- Department
of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Miriam L. Diamond
- Department
of Earth Sciences, University of Toronto, Toronto, Ontario M5S 3B1, Canada
- Dalla
Lana School of Public Health, University
of Toronto, Toronto, Ontario M5T 3M7, Canada
- School of
the Environment, University of Toronto, Toronto, Ontario M5S 3E8, Canada
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16
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Katona P, Kullar R, Zhang K. Bringing Transmission of SARS-CoV-2 to the Surface: Is there a Role for Fomites? Clin Infect Dis 2022; 75:910-916. [PMID: 35218181 PMCID: PMC8903442 DOI: 10.1093/cid/ciac157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Indexed: 01/22/2023] Open
Abstract
Understanding the contribution of routes of transmission, particularly the role of fomites in Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) transmission is important in developing and implementing successful public health infection prevention and control measures.This article will look at case reports, laboratory findings, animal studies, environmental factors, the need for disinfection, and differences in settings, as they relate to SARS-CoV-2 transmission.
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Affiliation(s)
- Peter Katona
- UCLA School of Medicine Dept. of Infectious Diseases and UCLA School of Public Health
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