Q Fever reporting: tip of the iceberg?

Regional Relative Risk, a Physics-Based Metric for Characterizing Airborne Infectious Disease Transmission

Airborne infectious disease transmission events occur over a wide range of spatial scales and can be an important means of disease transmission. Physics- and biology-based models can assist in predicting airborne transmission events, overall disease incidence, and disease control strategy efficacy. We describe a new theory that extends current approaches for the case in which an individual is infected by a single airborne particle, including the scenario in which numerous infectious particles are present in the air but only one causes infection. A single infectious particle can contain more than one pathogenic microorganism and be physically larger than the pathogen itself. This approach allows robust relative risk estimates even when there is wide variation in (i) individual exposures and (ii) the individual response to that exposure (the pathogen dose-response function can take any mathematical form and vary by individual). Based on this theory, we propose the regional relative risk-a new metric, distinct from the traditional relative risk metric, that compares the risk between two regions. In theory, these regions can range from individual rooms to large geographic areas. In this paper, we apply the regional relative risk metric to outdoor disease transmission events over spatial scales ranging from 50 m to 20 km, demonstrating that in many common cases minimal input information is required to use the metric. Also, we demonstrate that the model predictions are consistent with data from prior outbreaks. Future efforts could apply and validate this theory for other spatial scales, such as transmission within indoor environments. This work provides context for (i) the initial stages of an airborne disease outbreak and (ii) larger-scale disease spread, including unexpected low-probability disease "sparks" that potentially affect remote populations, a key practical issue in controlling airborne disease outbreaks. IMPORTANCE Airborne infectious disease transmission events occur over a wide range of spatial scales and can be important to disease outbreaks. We describe a new physics- and biology-based theory for the important case in which individuals are infected by a single airborne particle (even though numerous infectious particles can be emitted into the air and inhaled). Based on this theory, we propose a new epidemiological metric, regional relative risk, that compares the risk between two geographic regions (in theory, regions can range from individual rooms to large areas). Our modeling of transmission events predicts that for many scenarios of interest, minimal information is required to use this metric for locations 50 m to 20 km downwind. This prediction is consistent with data from prior disease outbreaks. Future efforts could apply and validate this theory for other spatial scales, such as indoor environments. Our results may be applicable to many airborne diseases a priori, as these results depend on the physics of airborne particulate dispersion.