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Dias M, Gomes B, Pena P, Cervantes R, Beswick A, Duchaine C, Kolk A, Madsen AM, Oppliger A, Pogner C, Duquenne P, Wouters IM, Crook B, Viegas C. Filling the knowledge gap: Scoping review regarding sampling methods, assays, and further requirements to assess airborne viruses. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 946:174016. [PMID: 38908595 DOI: 10.1016/j.scitotenv.2024.174016] [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: 02/12/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
Assessment of occupational exposure to viruses is crucial to identify virus reservoirs and sources of dissemination at an early stage and to help prevent spread between employees and to the general population. Measuring workers' exposure can facilitate assessment of the effectiveness of protective and mitigation measures in place. The aim of this scoping review is to give an overview of available methods and those already implemented for airborne virus' exposure assessment in different occupational and indoor environments. The results retrieved from the different studies may contribute to the setting of future standards and guidelines to ensure a reliable risk characterization in the occupational environments crucial for the implementation of effective control measures. The search aimed at selecting studies between January 1st 2010 and June 30th 2023 in the selected databases. Fifty papers on virus exposure assessment fitted the eligibility criteria and were selected for data extraction. Overall, this study identified gaps in knowledge regarding virus assessment and pinpointed the needs for further research. Several discrepancies were found (transport temperatures, elution steps, …), as well as a lack of publication of important data related to the exposure conditions (contextual information). With the available information, it is impossible to compare results between studies employing different methods, and even if the same methods are used, different conclusions/recommendations based on the expert judgment have been reported due to the lack of consensus in the contextual information retrieved and/or data interpretation. Future research on the field targeting sampling methods and in the laboratory regarding the assays to employ should be developed bearing in mind the different goals of the assessment.
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Affiliation(s)
- Marta Dias
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal
| | - Bianca Gomes
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; CE3C-Center for Ecology, Evolution and Environmental Change, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisbon, Portugal
| | - Pedro Pena
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal
| | - Renata Cervantes
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal
| | - Alan Beswick
- Health and Safety Executive Science and Research Centre, Buxton SK17 9JN, UK
| | - Caroline Duchaine
- Département de biochimie, microbiologie et bio-informatique, Université Laval, Québec, Canada
| | - Annette Kolk
- Institute for Occupational Safety and Health of the German Social Accident Insurance, Alte Heerstraße 111, 53757 Sankt Augustin, Germany
| | - Anne Mette Madsen
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 Copenhagen Ø, Denmark
| | | | | | | | - Inge M Wouters
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Brian Crook
- Health and Safety Executive Science and Research Centre, Buxton SK17 9JN, UK
| | - Carla Viegas
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal.
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2
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Tomazin R, Matos T. Mycological Methods for Routine Air Sampling and Interpretation of Results in Operating Theaters. Diagnostics (Basel) 2024; 14:288. [PMID: 38337804 PMCID: PMC10855394 DOI: 10.3390/diagnostics14030288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Many infectious diseases are transmitted via the air and are, therefore, particularly difficult to combat. These infections include various invasive mycoses caused by molds. The usual route of infection is the inhalation of conidia. In hospitals, infection can also occur through the deposition of conidia in otherwise sterile anatomical sites during surgical and other invasive procedures. Therefore, knowledge of airborne mold concentrations can lead to measures to protect patients from fungal infections. The literature on this topic contains insufficient and sometimes ambiguous information. This is evidenced by the fact that there are no international recommendations or guidelines defining the methodology of air sampling and the interpretation of the results obtained. Surgical departments, intensive care units and medical mycology laboratories are, therefore, left to their own devices, leading to significant differences in the implementation of mycological surveillance in hospitals. The aim of this mini-review is to provide an overview of the current methods of air sampling and interpretation of results used in medical mycology laboratories.
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Affiliation(s)
| | - Tadeja Matos
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
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3
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Doğantürk YE, Dağ-Güzel A, Kuşkucu MA. Development of a Nanoplate-Based Digital PCR Test Method for Quantitative Detection of Human Adenovirus DNA. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:353-366. [PMID: 38633848 PMCID: PMC10986707 DOI: 10.36519/idcm.2023.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/04/2023] [Indexed: 04/19/2024]
Abstract
Objective Digital polymerase chain reaction (dPCR) assay is an advanced PCR technique that allows for the simultaneous detection and absolute quantification of diverse pathogens.Commercially validated kits available for detecting all subtypes of human adenovirus (HAdV) are limited. This study aimed to demonstrate the development of an in-house nanoplate-based dPCR assay with high sensitivity, even at low copy numbers. Materials and Methods In this methodological study, the standardized HAdV DNA was prepared by amplifying the specific hexon gene region with real-time PCR and purifying the HAdV DNA using magnetic beads from HAdV-positive extractions. Dilutions were tested in triplicate during three independent runs to determine the dynamic range, the limit of detection (LoD), the limit of quantification (LoQ), precision, and reproducibility. The primer and probe sequences used in the study were selected based on a literature review to ensure the detection of all HAdV serotypes in a single run. The selected primers were verified using the US National Center for Biotechnology Information (NBCI) nBLAST tools, and the target sequence was determined using the BioEdit software. The DNA concentration of the stock solution was measured using a Qubit fluorometer. The estimated copy number of the stock solution per milliliter was calculated based on the length of the amplified base sequence and fluorometer measurement. Results The dynamic range of the test was determined to be from 770.4 to 0.9476 cp/μl, with the LoD and LoQ values both being 0.9476 cp/μl. The coefficient of determination (r 2) value of the test was 0.9986. Conclusion The results demonstrated that the dPCR method could be an ideal tool for the diagnosis and absolute quantification of human adenoviruses, especially in low copy numbers. In order to determine the reproducibility of the test and validate the method for field use, it needs to be developed and adapted in various laboratories and supported by clinical studies.
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Affiliation(s)
- Yağmur Eylül Doğantürk
- Department of Medical Microbiology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Türkiye
- Department of Medical Microbiology, İstanbul Aydın University School of Medicine, İstanbul, Türkiye
| | - Aylin Dağ-Güzel
- Department of Medical Microbiology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Türkiye
- Medical Laboratory Techniques, Arel University Junior Technical Collage, İstanbul, Türkiye
| | - Mert Ahmet Kuşkucu
- Department of Medical Microbiology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Türkiye
- Department of Medical Microbiology, Koç University School of Medicine, İstanbul, Türkiye
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4
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Carrazana E, Ruiz-Gil T, Fujiyoshi S, Tanaka D, Noda J, Maruyama F, Jorquera MA. Potential airborne human pathogens: A relevant inhabitant in built environments but not considered in indoor air quality standards. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 901:165879. [PMID: 37517716 DOI: 10.1016/j.scitotenv.2023.165879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/13/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023]
Abstract
Potential airborne human pathogens (PAHPs) may be a relevant component of the air microbiome in built environments. Despite that PAHPs can cause infections, particularly in immunosuppressed patients at medical centers, they are scarcely considered in standards of indoor air quality (IAQ) worldwide. Here, we reviewed the current information on microbial aerosols (bacteria, fungal and viruses) and PAHPs in different types of built environments (e.g., medical center, industrial and non-industrial), including the main factors involved in their dispersion, the methodologies used in their study and their associated biological risks. Our analysis identified the human occupancy and ventilation systems as the primary sources of dispersal of microbial aerosols indoors. We also observed temperature and relative humidity as relevant physicochemical factors regulating the dispersion and viability of some PAHPs. Our analysis revealed that some PAHPs can survive and coexist in different environments while other PAHPs are limited or specific for an environment. In relation to the methodologies (conventional or molecular) the nature of PAHPs and sampling type are pivotal. In this context, indoors air-borne viruses are the less studies because their small size, environmental lability, and absence of efficient sampling techniques and universal molecular markers for their study. Finally, it is noteworthy that PAHPs are not commonly considered and included in IAQ standards worldwide, and when they are included, the total abundance is the single parameter considered and biological risks is excluded. Therefore, we propose a revision, design and establishment of public health policies, regulations and IAQ standards, considering the interactions of diverse factors, such as nature of PAHPs, human occupancy and type of built environments where they develop.
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Affiliation(s)
- Elizabeth Carrazana
- Programa de Doctorado en Ciencias Mención Biología Celular y Molecular Aplicada, Universidad de La Frontera, Temuco, Chile; Laboratorio de Ecología Microbiana Aplicada, Departamento de Ciencias Químicas y Recursos Naturales, Universidad de La Frontera, Temuco, Chile
| | - Tay Ruiz-Gil
- Laboratorio de Ecología Microbiana Aplicada, Departamento de Ciencias Químicas y Recursos Naturales, Universidad de La Frontera, Temuco, Chile; Programa de Doctorado en Ciencias de Recursos Naturales, Universidad de La Frontera, Temuco, Chile
| | - So Fujiyoshi
- Center for Holobiome and Built Environment (CHOBE), Hiroshima University, Japan; Microbial Genomics and Ecology, PHIS, The IDEC institute, Hiroshima University, Hiroshima, Japan
| | - Daisuke Tanaka
- School of Science Academic Assembly, University of Toyama, Toyama, Japan
| | - Jun Noda
- Graduate School of Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan
| | - Fumito Maruyama
- Center for Holobiome and Built Environment (CHOBE), Hiroshima University, Japan; Microbial Genomics and Ecology, PHIS, The IDEC institute, Hiroshima University, Hiroshima, Japan
| | - Milko A Jorquera
- Laboratorio de Ecología Microbiana Aplicada, Departamento de Ciencias Químicas y Recursos Naturales, Universidad de La Frontera, Temuco, Chile; Center for Holobiome and Built Environment (CHOBE), Hiroshima University, Japan; Network for Extreme Environment Research (NEXER), Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco, Chile.
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5
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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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6
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Lee G, Yoo K. A review of the emergence of antibiotic resistance in bioaerosols and its monitoring methods. RE/VIEWS IN ENVIRONMENTAL SCIENCE AND BIO/TECHNOLOGY 2022; 21:799-827. [PMID: 35694630 PMCID: PMC9169023 DOI: 10.1007/s11157-022-09622-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/30/2022] [Indexed: 04/18/2023]
Abstract
Despite significant public health concerns regarding infectious diseases in air environments, potentially harmful microbiological indicators, such as antibiotic resistance genes (ARGs) in bioaerosols, have not received significant attention. Traditionally, bioaerosol studies have focused on the characterization of microbial communities; however, a more serious problem has recently arisen due to the presence of ARGs in bioaerosols, leading to an increased prevalence of horizontal gene transfer (HGT). This constitutes a process by which bacteria transfer genes to other environmental media and consequently cause infectious disease. Antibiotic resistance in water and soil environments has been extensively investigated in the past few years by applying advanced molecular and biotechnological methods. However, ARGs in bioaerosols have not received much attention. In addition, ARG and HGT profiling in air environments is greatly limited in field studies due to the absence of suitable methodological approaches. Therefore, this study comprehensively describes recent findings from published studies and some of the appropriate molecular and biotechnological methods for monitoring antibiotic resistance in bioaerosols. In addition, this review discusses the main knowledge gaps regarding current methodological issues and future research directions.
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Affiliation(s)
- Gihan Lee
- Department of Environmental Engineering, Korea Maritime and Ocean University, Busan, 49112 South Korea
- Interdisciplinary Major of Ocean Renewable Energy Engineering, Korea Maritime and Ocean University, Busan, 49112 South Korea
| | - Keunje Yoo
- Department of Environmental Engineering, Korea Maritime and Ocean University, Busan, 49112 South Korea
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7
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Bueno de Mesquita PJ, Delp WW, Chan WR, Bahnfleth WP, Singer BC. Control of airborne infectious disease in buildings: Evidence and research priorities. INDOOR AIR 2022; 32:e12965. [PMID: 34816493 DOI: 10.1111/ina.12965] [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: 08/18/2021] [Revised: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 06/13/2023]
Abstract
The evolution of SARS-CoV-2 virus has resulted in variants likely to be more readily transmitted through respiratory aerosols, underscoring the increased potential for indoor environmental controls to mitigate risk. Use of tight-fitting face masks to trap infectious aerosol in exhaled breath and reduce inhalation exposure to contaminated air is of critical importance for disease control. Administrative controls including the regulation of occupancy and interpersonal spacing are also important, while presenting social and economic challenges. Indoor engineering controls including ventilation, exhaust, air flow control, filtration, and disinfection by germicidal ultraviolet irradiation can reduce reliance on stringent occupancy restrictions. However, the effects of controls-individually and in combination-on reducing infectious aerosol transfer indoors remain to be clearly characterized to the extent needed to support widespread implementation by building operators. We review aerobiologic and epidemiologic evidence of indoor environmental controls against transmission and present a quantitative aerosol transfer scenario illustrating relative differences in exposure at close-interactive, room, and building scales. We identify an overarching need for investment to implement building controls and evaluate their effectiveness on infection in well-characterized and real-world settings, supported by specific, methodological advances. Improved understanding of engineering control effectiveness guides implementation at scale while considering occupant comfort, operational challenges, and energy costs.
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Affiliation(s)
| | - William W Delp
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - Wanyu R Chan
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - William P Bahnfleth
- Department of Architectural Engineering, Pennsylvania State University, State College, Pennsylvania, USA
| | - Brett C Singer
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, California, USA
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8
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Wang X, Wang D, Umar S, Qin S, Ling Q, Gray GC, Liu Y. Molecular typing of human adenoviruses among hospitalized patients with respiratory tract infections in a tertiary Hospital in Guangzhou, China between 2017 and 2019. BMC Infect Dis 2021; 21:748. [PMID: 34344310 PMCID: PMC8330471 DOI: 10.1186/s12879-021-06412-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/18/2021] [Indexed: 12/02/2022] Open
Abstract
Background Human Adenoviruses (HAdVs) cause a wide array of illnesses in all age groups. They particularly cause frequent morbidity among children. In China, human adenovirus types 3, 4, 7, 11, 14, 21, and 55 have caused at least seven outbreaks since 2000. However, limited studies are available regarding the epidemiological patterns and diversity of HAdVs types among hospitalized patients with respiratory tract infections (RTIs). Methods To understand the epidemiology and subtype distribution of HAdV infections associated with RTIs in China, nasal swab (NS) clinical samples were collected from 4129 patients in a Guangzhou hospital between August 2017 and October 2019. PCR, sequencing, and phylogenetic analysis were performed on these specimens to identify HAdV subtypes. Results HAdV was successfully sequenced in 99 (2.4%) of the 4129 NS specimens, with the highest HAdV prevalence (6.3%) found in children between the ages of 5 and 10 years. Among HAdV-positive specimens, the most prevalent genotypes identified were HAdV-B3 (55.6%) and HAdV-B7 (25.3%). The most common symptoms in the HAdV-infected patients were fever (100%), cough (80.8%), and rhinorrhea (71.8%). HAdV infections were detected throughout the year with a relatively higher prevalence in summer. Conclusion All ages suffer adenovirus infections, but young children are at the greatest risk. This study data demonstrates that at least three species of HAdVs (species B, C, and E) are circulating in Guangzhou City, China. As antiviral therapies and type-specific vaccines become available, such epidemiological data will be useful in guiding therapy and public health interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06412-0.
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Affiliation(s)
- Xinye Wang
- Global Health Research Center, Duke Kunshan University, Kunshan, China.,Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Dawei Wang
- Emergency Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, China
| | - Sajid Umar
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Sheng Qin
- Laboratory Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiong Ling
- Laboratory Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gregory C Gray
- Global Health Research Center, Duke Kunshan University, Kunshan, China. .,Division of Infectious Diseases, Duke University, School of Medicine, DUMC Box 102359, Durham, NC, 27710, USA. .,Duke Global Health Institute, Duke University, Durham, NC, USA. .,Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore.
| | - Yuntao Liu
- Emergency Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, China.
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9
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Binder RA, Alarja NA, Robie ER, Kochek KE, Xiu L, Rocha-Melogno L, Abdelgadir A, Goli SV, Farrell AS, Coleman KK, Turner AL, Lautredou CC, Lednicky JA, Lee MJ, Polage CR, Simmons RA, Deshusses MA, Anderson BD, Gray GC. Environmental and Aerosolized Severe Acute Respiratory Syndrome Coronavirus 2 Among Hospitalized Coronavirus Disease 2019 Patients. J Infect Dis 2020; 222:1798-1806. [PMID: 32905595 PMCID: PMC7499634 DOI: 10.1093/infdis/jiaa575] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
During April and May 2020, we studied 20 patients hospitalized with coronavirus disease 2019 (COVID-19), their hospital rooms (fomites and aerosols), and their close contacts for molecular and culture evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Among >400 samples, we found molecular evidence of virus in most sample types, especially the nasopharyngeal (NP), saliva, and fecal samples, but the prevalence of molecular positivity among fomites and aerosols was low. The agreement between NP swab and saliva positivity was high (89.5%; κ = 0.79). Two NP swabs collected from patients on days 1 and 7 post-symptom onset had evidence of infectious virus (2 passages over 14 days in Vero E6 cells). In summary, the low molecular prevalence and lack of viable SARS-CoV-2 virus in fomites and air samples implied low nosocomial risk of SARS-CoV-2 transmission through inanimate objects or aerosols.
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Affiliation(s)
- Raquel A Binder
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Natalie A Alarja
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Emily R Robie
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kara E Kochek
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Leshan Xiu
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,National Health Commission Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lucas Rocha-Melogno
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina, USA
| | - Anfal Abdelgadir
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Sumana V Goli
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Amanda S Farrell
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kristen K Coleman
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore
| | - Abigail L Turner
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Cassandra C Lautredou
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA
| | - John A Lednicky
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Mark J Lee
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | | | - Ryan A Simmons
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Marc A Deshusses
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina, USA
| | - Benjamin D Anderson
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Gregory C Gray
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore.,Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
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10
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Fennelly KP. Particle sizes of infectious aerosols: implications for infection control. THE LANCET. RESPIRATORY MEDICINE 2020; 8:914-924. [PMID: 32717211 PMCID: PMC7380927 DOI: 10.1016/s2213-2600(20)30323-4] [Citation(s) in RCA: 320] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
The global pandemic of COVID-19 has been associated with infections and deaths among health-care workers. This Viewpoint of infectious aerosols is intended to inform appropriate infection control measures to protect health-care workers. Studies of cough aerosols and of exhaled breath from patients with various respiratory infections have shown striking similarities in aerosol size distributions, with a predominance of pathogens in small particles (<5 μm). These are immediately respirable, suggesting the need for personal respiratory protection (respirators) for individuals in close proximity to patients with potentially virulent pathogens. There is no evidence that some pathogens are carried only in large droplets. Surgical masks might offer some respiratory protection from inhalation of infectious aerosols, but not as much as respirators. However, surgical masks worn by patients reduce exposures to infectious aerosols to health-care workers and other individuals. The variability of infectious aerosol production, with some so-called super-emitters producing much higher amounts of infectious aerosol than most, might help to explain the epidemiology of super-spreading. Airborne infection control measures are indicated for potentially lethal respiratory pathogens such as severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Kevin P Fennelly
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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Covid-19 Airborne Transmission and Its Prevention: Waiting for Evidence or Applying the Precautionary Principle? ATMOSPHERE 2020. [DOI: 10.3390/atmos11070710] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Besides the predominant ways of transmission of SARS-CoV-2 (namely, contacts and large droplets) the airborne one is increasingly taken into consideration as a result of latest research findings. Nevertheless, this possibility has been already suggested by previous studies on other coronaviruses including SARS-CoV and MERS-CoV. To describe the state of the art of coronaviruses and airborne transmission, a systematic review was carried out using the PRISMA methodology. Overall, 64 papers were selected and classified into three main groups: laboratory experiments (12 papers), air monitoring (22) and epidemiological and airflow model studies (30). The airborne transmission of SARS-CoV-2 is suggested by the studies of the three groups, but none has yet obtained complete evidence. The sampling and detection methods have not been validated, therefore monitoring results are affected by a possible underestimation. Then, epidemiological investigations only hypothesize the airborne transmission as a possible explanation for some illness cases, but without estimating its attributable risk. Nevertheless, while waiting for more evidence, it is urgent to base advice on preventive measures, such as the use of masks, safe distancing and air ventilation, on the precautionary principle.
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Airborne Influenza A Virus Exposure in an Elementary School. Sci Rep 2020; 10:1859. [PMID: 32024882 PMCID: PMC7002614 DOI: 10.1038/s41598-020-58588-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/17/2020] [Indexed: 01/26/2023] Open
Abstract
Influenza contributes significantly to childhood morbidity and mortality. Given the magnitude of the school-aged child population, a sizeable proportion of influenza virus transmission events are expected to occur within school settings. However, influenza virus activity in schools is not well-understood, likely due to our limited ability to accurately monitor for respiratory viruses without disrupting the school environment. In this study, we evaluated the use of a bioaerosol sampling method to noninvasively detect and quantify airborne influenza A virus (IAV) densities in a public elementary school. Air samples were collected from multiple locations in the school, two days per week, throughout an eight-week sampling period during influenza season. Real-time RT-PCR targeting the IAV M gene revealed detectable IAV on five occasions in densities ranging from 2.0 × 10−1 to 1.9 × 104. No significant differences in IAV densities were related to student presence/absence. The majority of IAV-associated particles were ≤4 μm in diameter, and theoretical calculations indicate infectious thresholds after minutes of exposure. Our study represents the first identification and quantification of airborne influenza virus in an elementary school, and the results suggest that airborne IAV has the potential to circulate in schools during influenza season, in large enough doses known to cause infection.
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