Particle sizes of infectious aerosols: implications for infection control

Infection prevention and control measures during the COVID-19 pandemic and airborne tuberculosis transmission during primary care visits in South Africa

BACKGROUND

Tuberculosis (TB) transmission in crowded health care settings poses considerable risks in high-burden regions. We assessed how COVID-19 pandemic-related infection prevention and control (IPC) measures might impact TB transmission in a South African primary care clinic.

METHODS

In 2019 (pre-pandemic) and 2021 (pandemic), we collected clinical data, patient tracking data (person-time and spatial density), indoor CO2 levels, and concentrations of Mycobacterium tuberculosis (Mtb) DNA in bio-aerosol samples. We estimated the risk of Mtb transmission during a one-hour visit based on ventilation rate and duration of exposure.

RESULTS

During the pandemic, clinics were less crowded, with lower mean person-time per day (209 vs. 258 hours; p<0.001). TB prevalence among patients also declined (2.3% vs. 8.8%; p<0.001). Environmental indicators suggested improved air quality, with lower CO₂ levels (555 vs. 856 ppm; p<0.001) and higher ventilation rates (15.8 vs. 6.3 air changes per hour; p<0.001). These changes corresponded with a reduction in modeled Mtb transmission risk (0.04% vs. 1.36%; p=0.046). Airborne Mtb DNA was detected in both periods.

CONCLUSIONS

Pandemic-related IPC measures to control COVID-19 transmission were rigorously implemented and likely reduced transmission of airborne respiratory infections, supporting their continued implementation in healthcare settings post-pandemic.

Worker risk from ultrasonicator aerosolization in medical device reprocessing: a particulate and bio-burden approach

BACKGROUND

Reprocessing reusable medical devices and surgical instruments is vital for ensuring safe health care in hospitals. Medical device reprocessing departments (MDRDs) handle the cleaning, disinfection and sterilization of these instruments. While previous research has examined bioburden on surfaces and associated patient health risks, there is limited focus on occupational hazards for MDRD workers.

AIM

To investigate the potential bioaerosol exposure and particle concentrations generated by ultrasonic sterilizing water baths within the MDRD at Mount Sinai Hospital, Toronto, Canada.

METHODS

Bioaerosol sampling was conducted using Andersen-style samplers for bacterial and fungal cultures. Particle sampling was measured using optical particle samplers.

RESULTS

The majority of bioaerosols were composed of low-risk skin microflora and waterborne bacteria, predominantly Micrococcus luteus and Staphylococcus spp. However, potentially harmful bacteria such as Citrobacter spp. and Acinetobacter spp. were detected. Fungal genera identified included Aspergillus, Cladosporium and Penicillium.

CONCLUSIONS

Although the overall aerosol generation from ultrasonic cleaning appeared minimal, this study highlights the importance of appropriate personal protective equipment, and suggests the need for further research on ventilation and additional aerosol sources in MDRDs.

Measuring the fitted filtration efficiency of cloth masks, medical masks and respirators

IMPORTANCE

Masks reduce transmission of SARS-CoV2 and other respiratory pathogens. Comparative studies of the fitted filtration efficiency of different types of masks are scarce.

OBJECTIVE

To describe the fitted filtration efficiency against small aerosols (0.02-1 µm) of medical and non-medical masks and respirators when worn, and how this is affected by user modifications (hacks) and by overmasking with a cloth mask.

DESIGN

We tested a 2-layer woven-cotton cloth mask of a consensus design, ASTM-certified level 1 and level 3 masks, a non-certified mask, KF94s, KN95s, an N95 and a CaN99.

SETTING

Closed rooms with ambient particles supplemented by salt particles.

PARTICIPANTS

12 total participants; 21-55 years, 68% female, 77% white, NIOSH 1-10.

MAIN OUTCOME AND MEASURE

Using standard methods and a PortaCount 8038, we counted 0.02-1 µm particles inside and outside masks and respirators, expressing results as the percentage filtered by each mask. We also studied level 1 and level 3 masks with earguards, scrub caps, the knot-and-tuck method, and the effects of braces or overmasking with a cloth mask.

RESULTS

Filtration efficiency for the cloth mask was 47-55%, for level 1 masks 52-60%, for level 3 masks 60-77%. A non-certified KN95 look-alike, two KF94s, and three KN95s filtered 57-77%, and the N95 and CaN99 97-98% without fit testing. External braces and overmasking with a well-fitting cloth mask increased filtration, but earguards, scrub caps, and the knot-and-tuck method did not.

LIMITATIONS

Limited number of masks of each type sampled; no adjustment for multiple comparisons.

CONCLUSIONS AND RELEVANCE

Well-fitting 2-layer cotton masks filter in the same range as level 1 masks when worn: around 50%. Level 3 masks and KN95s/KF94s filter around 70%. Over a level 1 mask, external braces or overmasking with a cloth-mask-on-ties produced filtration around 90%. Only N95s and CaN99s, both of which have overhead elastic, performed close to the occupational health and safety standards for fit tested PPE (>99%), filtering at 97-99% when worn, without formal fit testing. These findings inform public health messaging about relative protection from aerosols afforded by different mask types and explain the effectiveness of cloth masks observed in numerous epidemiologic studies conducted in the first year of the pandemic. A plain language summary of these findings is available at https://maskevidence.org/masks-compared.

Candidate transmission survival genome of Mycobacterium tuberculosis

Mycobacterium tuberculosis (Mtb), a leading cause of death from infection, completes its life cycle entirely in humans except for transmission through the air. To begin to understand how Mtb survives aerosolization, we mimicked liquid and atmospheric conditions experienced by Mtb before and after exhalation using a model aerosol fluid (MAF) based on the water-soluble, lipidic, and cellular constituents of necrotic tuberculosis lesions. MAF induced drug tolerance in Mtb, remodeled its transcriptome, and protected Mtb from dying in microdroplets desiccating in air. Yet survival was not passive: Mtb appeared to rely on hundreds of genes to survive conditions associated with transmission. Essential genes subserving proteostasis offered most protection. A large number of conventionally nonessential genes appeared to contribute as well, including genes encoding proteins that resemble antidesiccants. The candidate transmission survival genome of Mtb may offer opportunities to reduce transmission of tuberculosis.

SOLARIS project: a portable 3D-printed bioaerosol sampler for environmental bacterial collection

Bioaerosols, a subset of aerosols released from the biosphere, can carry pathogens, and include particles with diameters from nanometres to a few micrometres. They can remain suspended indoors and travel significant distances. Bioaerosol studies play a vital role in public health, as bioaerosols are an effective route for human and animal pathogen transmission, especially in animal production and handling facilities, which are considered hotspots for the emergence of zoonotic pathogens. The 'One Health' approach, which interconnects human, animal and environmental health, underscores the need for robust biomonitoring and biosurveillance systems. We introduce the SOLARIS project, a novel bioaerosol sampler manufactured through three-dimensional printing with a biocompatible material. Our sampler is compact, portable and uses a liquid collection medium, increasing bioefficiency. Our sampler's laboratory testing demonstrated the successful separation of viable Escherichia coli bacteria from artificially generated bioaerosols. Collected samples were found suitable for downstream analysis methods such as culturing, mass spectrometry, molecular detection and electron microscopy. A field trial at a swine facility was performed, in which Clostridioides difficile spores were successfully collected from bioaerosols and identified using microbiological and molecular methods, reinforcing our sampler's utility and emphasizing the significance of incorporating aerosol samples in research studies within the One Health approach.

Total outward leakage of face-worn products used by the general public for source control

BACKGROUND

During Coronavirus disease 2019 pandemic, the general public used any face-worn products they could get to overcome the shortage of N95 respirators and surgical masks. These products, often not meeting any standards, raised concerns about their effectiveness in reducing the spread of respiratory viruses.

METHODS

This study quantified total outward leakage (TOL) of units from 9 face-worn product categories used by members of the general public. A benchtop system was devised to test 2 units from each category on 2 different-sized headforms with silicone elastomer skin. Each unit was donned 5 times per headform.

RESULTS

Both face-worn product category and headform size significantly affected TOL (P value < .05). The TOL of tested face-worn products varied from 10% to 58% depending on both model and headform size. Face-worn products donned on the medium headform had a higher mean TOL compared to those donned on the larger headform.

CONCLUSIONS

Overall, single-layer cloth masks are the least effective measure for source control due to their highest TOL among the tested face-worn products. Three-layer disposable face masks may be a favorable option for source control among the public. A standard should be developed for face-worn product design and manufacturing to accommodate different facial sizes.

Estimating Mycobacterium tuberculosis transmission in a South African clinic: Spatiotemporal model based on person movements

The risk of Mycobacterium tuberculosis (Mtb) transmission can be high in crowded clinics. We developed a spatiotemporal model of airborne Mtb transmission based on the Wells-Riley equation. We collected environmental, clinical and person-tracking data in a South African clinic during COVID-19, when community or surgical masks were compulsory and ventilation was increased. We matched person movements with clinical records to identify the spatiotemporal location of infectious TB patients. We modeled the concentration of infectious doses (quanta) and estimated the individual risk of infection. Over five days, video sensors tracked 1,438 clinic attendees. CO2 levels were low (median 431 ppm, IQR 406 ppm-458 ppm); the quanta concentration was higher in the morning than in the afternoon, and highest in the waiting room. The estimated risk of infection per clinic attendee was 0.05% (80%-credible interval (CrI) 0.01%-0.06%). It increased with the number of close contacts with infectious patients and the time spent in the clinic, and was 1.3-fold (95%-CrI 1.2-1.4) higher in scenarios without mask use and 2.1-fold (95%-CrI 0.9-5.0) higher with pre-pandemic ventilation rates, emphasizing the importance of ventilation. Spatiotemporal modeling can identify high-risk areas and evaluate the impact of infection control measures in clinics.

Concentration, pathogenic composition, and exposure risks of bioaerosol in large indoor public environments: A comparative study of urban and suburban areas

Biological contamination in larger indoor environments can lead to the outbreak of various infectious diseases. This study aimed to compare the pollution profiles and associated health risks of airborne microorganisms in different indoor settings between urban and suburban areas by culturing, sequencing, and toxicological evaluation. The results indicated that the average level of culturable bacteria was higher in urban areas (955 ± 259 CFU/m3) compared to suburban areas (850 ± 85 CFU/m3), with the highest concentrations found in the market (2170 ± 798 CFU/m3) and gymnasium (2010 ± 300 CFU/m3). Conversely, the total number of airborne bacteria was higher in classroom (2.09 × 105) and laboratory (1.95 × 105 copies/m3), likely due to the presence of viable but non-culturable cells. Additionally, the concentrations of 0.5-2.0 μm total particles were higher in the market and cafeteria. Dominant airborne genera included Acinetobacter and Pseudomonas for bacteria, Cladosporium and Aspergillus for fungi, as well as Geneviridae and Herpesviridae for viruses. Bacterial and viral diversity and richness were significantly higher in suburban areas compared to urban areas, with distinct viral communities observed in hospital. Cytotoxicity assays revealed lower viability of cells in response to bioaerosols from the library (52.3 %) and laboratory (54.5 %); while lower proliferation rates were found for the cells exposed to bioaerosol from gymnasium (5.4 %) and market (6.0 %), suggesting higher toxicity of these environments. Additionally, bioaerosol exposure may impair cellular innate immunity by increasing the expression of IL-6, IL-8, TNF-α, IFN-γ. Our findings provide valuable information for assessing and controlling bioaerosol-related health risks in indoor environments.

Shape-dependent aerosol dynamics in indoor environments: Penetration, deposition, and dispersion

Particle shape exerts a significant influence on their dynamic behavior, and it is imperative to elucidate these effects given the potential for severe environmental toxicity associated with shaped particles. Despite extensive research on the dynamical processes of spherical particles, the behaviors of non-spherical particles have been insufficiently investigated. In this study, we have developed a suite of computation-based models that account for particle shape and have reported on the typical dynamical behaviors of non-spherical particles within indoor environments. We have explored three typical scenarios, i.e., particle penetration into indoor spaces through building cracks, indoor particle deposition, and indoor particle dispersion. The shape-induced deviations are associated with dynamical processes, showing a decrease trend among penetration, deposition, and dispersion of the non-spherical particles. The maximum discrepancy due to particle shape during the penetration process exceeds 1000 %, observed with particles of approximately 0.02 μm in diameter interacting with straight cracks 4.5 cm in length and 0.25 mm in height. Moreover, there is a discrepancy of more than 70 % in the deposition of particles with a diameter of approximately 10 μm on side walls when using side air supply ventilation. Similarly, a discrepancy of nearly 11 % is noted for particles around 0.02 μm in diameter during dispersion under displacement ventilation within indoor settings. The interaction between shape-related particle dynamics, particularly their diffusion characteristics, and the properties of the flow field leads to these shape-dependent dynamical discrepancies. These findings offer a comprehensive understanding of how the shape of particles affects their indoor dynamic behavior, thereby supporting the control of hazardous particles in indoor environments.

Experimental study of liquid drop impact on granular medium: Drop spreading/splashing and particle ejection

The impact of a liquid drop on a granular medium is a common phenomenon in nature and engineering. The possible splashing droplets and ejected particles could pose a risk of pathogen transmission if the water source or granular medium is contaminated. This work studies the liquid drop impact on the granular medium using high-speed photography and considers the effects of liquid properties, drop impact characteristics, and granular medium properties. Four flow regimes, including direct penetration, prompt splashing, spreading, and corona splashing, are observed and a regime map is created to identify their thresholds. The spreading regime can eject a large number of particles, and the corona splashing regime can produce splashing droplets in addition to the ejected particles. For the splashing droplets, their median diameters and velocities are in the ranges 0.11 to 0.21 and 0.15 to 0.37 of the diameter and velocity of the impact drop, and their median splashing angles range from 14° to 27°. Two particle ejection mechanisms are observed, falling squeeze and forward collision, driven by the collapsing and forward spreading of the liquid lamella, respectively. The particles ejected by the latter mechanism have larger ejection velocities, angles and distances from the impact center, which can facilitate their long-range transmission. In addition, the process of spreading and retracting of the lamella formed by the drop impact is also studied, and it is found that the maximum spreading diameter of the lamella is proportional to the crater diameter. These results improve the understanding of the phenomenon after the drop impact on the granular medium and the characteristics of the splashing droplets and ejected particles, contributing to the prediction and risk assessment of contaminated particle transmission.

LungVis 1.0: an automatic AI-powered 3D imaging ecosystem unveils spatial profiling of nanoparticle delivery and acinar migration of lung macrophages

Targeted (nano-)drug delivery is essential for treating respiratory diseases, which are often confined to distinct lung regions. However, spatio-temporal profiling of drugs or nanoparticles (NPs) and their interactions with lung macrophages remains unresolved. Here, we present LungVis 1.0, an AI-powered imaging ecosystem that integrates light sheet fluorescence microscopy with deep learning-based image analysis pipelines to map NP deposition and dosage holistically and quantitatively across bronchial and alveolar (acinar) regions in murine lungs for widely-used bulk-liquid and aerosol-based delivery methods. We demonstrate that bulk-liquid delivery results in patchy NP distribution with elevated bronchial doses, whereas aerosols achieve uniform deposition reaching distal alveoli. Furthermore, we reveal that lung tissue-resident macrophages (TRMs) are dynamic, actively patrolling and redistributing NPs within alveoli, contesting the conventional paradigm of TRMs as static entities. LungVis 1.0 provides an advanced framework for exploring pulmonary delivery dynamics and deepening insights into TRM-mediated lung immunity.

Assessment of Sub-micrometer-Sized Particles with Practical Activities in an Underground Coal Mine

This assessment was designed to explore and characterize the airborne particles, especially for the sub-micrometer sizes, in an underground coal mine. Airborne particles present in the breathing zone were evaluated by using both (1) direct reading real-time instruments (RTIs) to measure real-time particle number concentrations in the workplaces and (2) gravimetric samplers to collect airborne particles to obtain mass concentrations and conduct further characterizations. Airborne coal mine particles were collected via three samplers: inhalable particle sampler (37 mm cassette with polyvinyl chloride (PVC) filter), respirable dust cyclone (10 mm nylon cyclone with 37 mm Zefon cassette and PVC filter), and a Tsai diffusion sampler (TDS). The TDS, a newly designed sampler, is for collecting particles in the nanometer and respirable size range with a polycarbonate filter and grid. The morphology and compositions of collected particles on the filters were characterized using electron microscopy (EM). RTIs reading showed that the belt entry had a greatly nine-times higher total particle number concentration in average (~ 34,700 particles/cm3) than those measured at both the underground entry and office building (~ 4630 particles/cm3). The belt entry exhibited not only the highest total particle number concentration, but it also had different particle size fractions, particularly in the submicron and smaller sizes. A high level of submicron and nanoparticles was found in the belt conveyor drift area (with concentrations ranging from 0.54 to 1.55 mg/m3 among three samplers). The data support that small particles less than 300 nm are present in the underground coal mine associated with dust generated from practical mining activities. The chemical composition of the air particles has been detected in the presence of Ca, Cu, Si, Al, Fe, and Co which were all found to be harmful to miners when inhaled.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42461-024-01140-w.

Microfluidics-based condensation bioaerosol sampler for multipoint airborne virus monitoring

To facilitate rapid monitoring of airborne viruses, they must be collected with high efficiency and concentrated in a small volume of a liquid sample. In addition, the development of low-cost miniaturized samplers is essential for multipoint monitoring. Thus, in an attempt to fulfill these requirements, this study developed a microfluidic condensation bioaerosol sampler (MCBS). The developed sampler comprised two parts: a virus growth section and a virus droplet-to-liquid sample conversion section, each of which was fabricated on a chip using microfluidic technology. The condensation nucleus growth technique used in the virus growth section grew nanometer-sized airborne viruses into micro-sized droplets, making it possible to collection of viruses easier and with high efficiency. In addition, the virus droplet-to-liquid sample conversion section controlled the transport of droplets based on electrowetting technology. This enabled the collected airborne viruses to be concentrated in tens of microliters of the liquid sample. To evaluate the performance of both the sections, the virus dropletization, virus collection efficiency, and virus droplet-to-liquid sample conversion efficiency were evaluated through quantitative experiments. H1N1 and HCOV-229E viruses were used to conduct quantitative experiments on MCBS. We could obtain virus liquid samples with at 72.8- and 89.9-times higher concentration through 1:1 evaluation with a commercial sampler. Thus, the developed sampler facilitated efficient collection and concentration of airborne viruses in a compact, cost-effective manner. This is expected to facilitate rapid and accurate multipoint monitoring of viral aerosols.

Microbial ocean-atmosphere transfer: The influence of sewage discharge into coastal waters on bioaerosols from an urban beach in the subtropical Atlantic

All over the world, the oceans are the final destination of sewage transported by river estuaries, rainwater and other coastal discharges. The risks to human health related to direct contact with water and consumption of contaminated fish are well known, but little is known about the potential for atmospheric exposure to pollutants and pathogens from contaminated seawater. The release of microbial particles from the sea into the atmosphere occurs mainly by the eruption of rising bubbles through the sea surface microlayer (SML) or by sea spray. We investigated the heterotrophic bacteria density and relative abundance in SML and bioaerosols originated on the seafront of Fortaleza (Atlantic coastal zone, northeastern Brazil) influenced by wastewater disposal. There was a difference in the density of total heterotrophic bacteria (THB) according to the matrix analyzed during two seasons: the bacterial count was highest in the SML during the rainy season while the highest number of bacteria in bioaerosols samples was recorded during the dry season. Twenty-nine bacterial taxonomic groups were identified with variable abundance for both environments. These were the same in both matrices, with environmental variables influencing their abundance and composition. The contribution of the marine and continental environments in shaping the microbiota of the SML and coastal bioaerosols was clear, with the constant and representative presence of Enterobacteria standing out. The aerosolization of bacteria resulting from the discharge of untreated sewage is an important issue related to coastal environmental health and ecological safety.

A multicentre observational study of paediatric head and neck abscesses

INTRODUCTION

In winter of 2022/3 paediatric ENT surgeons across the UK observed that the incidence of severe abscesses in the head and neck and associated complications was higher than seen in previous years. We aimed to collate and evaluate data from across the UK to establish if this was a true rise in cases, and to describe the factors associated.

METHODS

A multicentre retrospective data collection was undertaken from 13 units across the UK. Patients admitted between September 2022-February 2023 with a head and neck abscess including sinogenic, otogenic, deep and superficial neck abscesses were included. Demographic, disease specific, management and outcome data were collected. Hospital episode statistic data were also requested and analysed to allow for comparison with previous 10 years of head and neck abscesses.

RESULTS

262 patients with abscesses of the head and neck were admitted during the study period, 100 between September and November and 163 between December and February. Mastoid abscesses were the most common abscess across both groups. The rate of group A streptococcus + culture results rose significantly from 12 % in autumn group to 30 % in winter (p = 0.02). The rate of intracranial complications rose from 10 % to 18 % (p = 0.11) and the rate of venous thrombosis rose over the same timeframe from 3 % to 14 % (p = 0.01).

DISCUSSION

This study demonstrated a statistically significant rise in the rate of group A streptococcus associated abscesses when comparing Autumn and Winter 2022/2023. Over the same timeframe a statistically significant rise in the proportion of patients with venous thromboses associated with H&N abscesses was noted. Interestingly, despite perceived national consensus regarding a spike in abscess incidence, the number of abscesses seen in winter 2022/2023 was in keeping with expected rates of paediatric H&N abscesses, based on pre covid year-on-year rise in incidence.

Interactive Simulation of Nonpharmaceutical Interventions of Airborne Disease Transmission in Office Settings

The COVID-19 pandemic has caused major disruptions to workplace safety and productivity. A browser-based interactive disease transmission simulation was developed to enable managers and individuals (agents) to optimize safe office work activities during pandemic conditions. The application provides a user interface to evaluate the impact of non-pharmaceutical interventions (NPIs) policies on airborne disease exposure based on agents' meeting patterns and room properties. Exposure is empirically calibrated using CO2 as a proxy for viral aerosol dispersion. For the building studied, the major findings are that the cubicles during low occupancy produce unexpectedly high exposure, upgrading meetings to larger rooms reduces total average exposure by 44%, and when all meetings are conducted in large rooms, a 79% exposure reduction is realized.

Administration of airborne pathogens in non-human primates

PURPOSE

Airborne pathogen scan penetrate in human respiratory tract and can cause illness. The use of animal models to predict aerosol deposition and study respiratory disease pathophysiology is therefore important for research and a prerequisite to test and study the mechanism of action of treatment. NHPs are relevant animal species for inhalation studies because of their similarities with humans in terms of anatomical structure, respiratory parameters and immune system.

MATERIALS AND METHODS

The aim of this review is to provide an overview of the state of the art of pathogen aerosol studies performed in non-human primates (NHPs). Herein, we present and discuss the deposition of aerosolized bacteria and viruses. In this review, we present important advantages of using NHPs as model for inhalation studies.

RESULTS

We demonstrate that deposition in the respiratory tract is not only a function of aerosol size but also the technique of administration influences the biological activity and site of aerosol deposition. Finally, we observe an influence of a region of pathogen deposition in the respiratory tract on the development of the pathophysiological effect in NHPs.

CONCLUSION

The wide range of methods used for the delivery of pathogento NHP respiratory airways is associated with varying doses and deposition profiles in the airways.

Development of optimal indoor air disinfection and ventilation protocols for airborne infectious diseases

Since the COVID-19 pandemic, there has been persistent emphasis on the importance of indoor air disinfection and ventilation in isolation units in the hospital environment. Nevertheless, no optimal and concrete disinfection protocol has been proposed to inactivate the viruses as quickly as possible. In this study, we experimentally evaluated various ventilation and disinfection protocols based on the combination of negative-pressure ventilation, ultraviolet (UV) light illumination, and Hypochlorous acid (HOCl) spray against three active virus species in a 3.5 cubic meters isolation unit. This small-size unit has gained attention during the pandemic due to the high demand for compact mobile laboratory systems capable of rapid disease diagnosis. In accordance with the WHO laboratory biosafety guidance, which states that all enclosed units where diagnostic work is conducted must ensure proper ventilation and disinfection activities, we aim to propose virus removal protocols for units compact enough to be installed within a van or deployed outdoor. The results confirmed the superiority (in terms of virus removal rate and time required) of the virus removal methods in the order of UV light, ventilation, and HOCl spray. Ultimately, we propose two optimal protocols: (i) UV light alone for three minutes, and (ii) UV light with ventilation for three minutes, followed by one-minute ventilation only. The time span of three minutes in the latter protocol is based on the clinical practice such that the medical staffs have a sufficient time to process the samples taken in transition to next patient to care.

Efficacy and feasibility of a novel semi-facial respirator with chitosan nanoparticles on the incidence of SARS-CoV-2 infection in healthcare professionals: randomized controlled trial

BACKGROUND

Evidence suggests that semi-facial respirators provide protection against contamination in high-risk environments, although the COVID-19 pandemic called for greater protection and viral inactivation capacity. Thus, the aim of this study was to investigate the efficacy of a novel semi-facial respirator containing chitosan nanoparticles, compared with a conventional N95 respirator on the incidence of laboratory-confirmed SARS-CoV-2 in healthcare professionals. The secondary outcomes were influenza infection, usability and comfort.

METHODS

Randomized controlled trial within a large public hospital (reference for COVID-19 patients) carried out between March 2021 and June 2023. We included 230 healthcare professionals exposed to SARS-Cov-2 and influenza, working in emergency departments, hospital wards, and intensive care units. Participants were assessed at baseline, after 10 days, and 21 days of follow-up. Researchers, participants, and outcome assessors were blinded to the allocated groups. Outcomes were analyzed by bivariate and multivariate comparisons using logistic regression. Crude (cOR) and adjusted odds ratios (aOR) were estimated, followed by 95% confidence intervals (CIs 95%). We adopted intention-to-treat (ITT) and complete-case (CC) analyses.

RESULTS

Baseline characteristics were considered homogeneous between groups, and usability and comfort were reported as excellent in both groups. Non-significant differences were found for all outcomes, both in the ITT and CC analyses. The incidence of COVID-19 and influenza were, respectively, cOR: 0.96 [CI95%: 0.21-4.42] and cOR: 1.25 [CI95%: 0.34-4.62]; and aOR: 1.08 [CI95%: 0.21-5.47] and aOR: 1.11 [CI95%: 0.17-7.01].

CONCLUSIONS

We found that the incidence of SARS-Cov-2 and influenza infections were similar between the new respirator compared to the conventional respirator. Furthermore, we observed that usability and comfort were similar and considered excellent for both respirators.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT04490200, 29/07/2020).

Propagation and evaporation of contaminated droplets, emission and exposure in surgery environments revealed by laser visualization and numerical characterization

The contaminated liquid mixture containing mucosalivary fluid and blood would be aerosolized during medical procedures, resulting in higher-risk exposures. The novelty of this research is integrating laser visualization and numerical characterization to assess the propagation and evaporation of contaminated droplets, and the interactive effects of humidity and temperature on exposure risks will be numerically evaluated in surgery environments. The numerical model evidenced by experiments can predict the mass balance of ejection droplets, the minimum required fallow time (FT) between appointments, and the disinfection region of greatest concern. Around 98.4 % of the ejection droplet mass will be removed after the cessation of ultrasonic scaling, while the initial droplet size smaller than 72.6μm will dehydrate and become airborne. The FT recommendation of 30 min is not over-cautious, and the extended FT (range of 28-37 min) should be instituted for low temperature (20.5 °C) and high humidity levels (60 %RH). The variation of the temperature and humidity in the range for human thermal comfort has little influence on the area of the disinfection region (0.15m2) and the cut-off size (72.6μm) of droplet deposition and suspension. This research can provide scientific evidence for the guidelines of environmental conditions in surgery rooms.

Aerosolization ocular surface microorganisms accumulation effect during non-contact tonometer measurements

PURPOSE

This study aimed to verify that aerosolization ocular surface microorganisms (AOSMs) accumulated during non-contact tonometry (NCT) measurements.

METHODS

A total of 508 participants (740 eyes) were enrolled in the study. In Experiment 1, before NCT was performed on each eye, the air was disinfected, and environment air control samples were collected via Air ideal® 3P (Bio Merieux). During NCT measurements, microbial aerosol samples were collected once from each eye. In Experiment 2, we collected initial blank control samples and then repeated Experiment 1. Finally, in Experiment 3, after the background microbial aerosol investigation, we cumulatively sampled AOSMs from each 10 participants then culture once, without any interventions to interrupt the accumulation. The collected samples were incubated and identified using matrix-assisted laser desorption/ ionization time-of-flight mass spectrometry (MALDI-TOF-MS).

RESULTS

Pathogenic Aerococcus viridans and other microorganisms from human eyes can spread and accumulate in the air during NCT measurements. The species and quantity of AOSMs produced by NCT measurements can demonstrate an accumulation effect.

CONCLUSION

AOSMs generated during NCT measurements are highly likely to spread and accumulate in the air, thereby may increase the risk of exposure to and transmission of bio-aerosols.

Pathogen shape: Implication on pathogenicity via respiratory deposition

The shape of environmental aerosols contributes to the discrepancy in their dynamic behavior compared to spherical particles, which have received inadequate consideration. We reported deposition patterns of aerosols and aerosol-transmissible pathogens in real human respiratory systems, taking into account their actual shape, using a validated computational-based model. We found that the shape of the aerosols significantly influenced its deposits and accessibility within the respiratory system, significantly in the tracheobronchial region. As an example, we estimated that over 180 % of differences in deposits in the trachea and bronchi were attributable to pathogens shape, inferring the underlying pathogenicity difference of these regions. These findings, capturing the spatial heterogeneity of pathogens and aerosols deposition in human respiratory system, have major implication for understanding the evolution of aerosol-related disease.

Temporal changes in the size resolved fractions of bacterial aerosols in urban and semi-urban residences

Despite the significant amount of time spent in the domestic environment, culture-independent size distribution data of bioaerosols are largely missing. This study investigated the temporal changes in size-resolved bacterial aerosols in urban and semi-urban residential settings. Overall, airborne bacterial taxa identified in both sites were dispersed across particles of various sizes. qPCR analysis showed that outdoors bacteria dominated particles > 8 μm, whilst indoor bacterial loadings were greater with 1-2 μm (winter) and 2-4 μm (summer) ranges. Indoor and outdoor aerosols harboured distinct bacterial communities due to the dominance of human-associated taxa (Staphylococcus, Micrococcus, Corynebacterium) in indoor air. The aerosol microbiome exhibited significant temporal variation, with Actinobacteria, Gammaproteobacteria and Bacilli predominant indoors, whereas Actinobacteria, Alphaproteobacteria and Gammaproteobacteria were the most abundant taxa outdoors. The variation between the two residences was mostly driven by particles < 2 μm, whereas differences between indoors and outdoors were mostly influenced by particles > 2 μm. Source-tracking analysis estimated that household surfaces accounted for the greatest source proportion of bacteria, surpassing that of outdoor air, which varied due to natural ventilation throughout the year. Our findings provide new insights into the factors governing the aerosol microbiome in residential environments which are crucial for exposure assessment.

Effects of recirculation and air change per hour on COVID-19 transmission in indoor settings: A CFD study with varying HVAC parameters

COVID-19 has already claimed over 7 million lives and has infected over 775 million people globally [1]. SARS-CoV-2, the virus that causes Covid-19, spreads primarily through droplets from infected people's airways, rendering Heating, Ventilation, and Air Conditioning (HVAC) systems critical in controlling infection risk levels in the indoor environment. To understand the dynamics of exhaled droplets and aerosols and the percentage of particles that are inhaled, escaped, recirculated, or trapped on different surfaces for a variety of environmental settings, we have presented our findings from the Computational Fluid Dynamics (CFD) modeling to investigate the impact of changing HVAC parameters in this paper. When combined with the spatial and temporal distribution of droplets, this method can be used to assess the potential risk and strengthen resilience. This finding demonstrates the viability and usefulness of CFD for modeling the distribution and dynamics of droplets and aerosols in confined environments. Our study demonstrates that raising the Air Change per Hour (ACH) from 2 to 8 reduces the risk of particle inhalation by nearly 70 %. Additionally, limiting the amount of air recirculation or increasing the amount of fresh air helps to reduce the number of airborne particles in an indoor space. To reduce the potential for respiratory droplet-related transmission and to provide relevant recommendations to the appropriate authority, the same computational approach could be applied to a wide range of ventilated indoor environments such as public buses, restaurants, exhibitions, and theaters.

Versatile filter membrane for effective sampling and real-time quantitative detection of airborne pathogens

Construction of air filter membranes bearing prominent collecting and transferring capability is highly desirable for detecting airborne pathogens but remains challenging. Here, a hyaluronic acid air filter membrane (HAFM) with tunable heterogeneous micro-nano porous structures is straightforwardly constructed through the ethanol-induced phase separation strategy. Airborne pathogens can be trapped and collected by HAFM with high performance due to the ideal trade-off between removal efficiency and pressure drop. By exempting the sample elution and extraction processes, the HAFM after filtration sampling can not only directly disperse on the agar plate for colony culture but also turn to an aqueous solution for centrifugal enrichment, which significantly reduces the damage and losses of the captured microorganisms. The following combination with ATP bioluminescence endows the HAFM with a real-time quantitative detection function for the captured airborne pathogens. Benefiting from high-efficiency sampling and non-traumatic transfer of airborne pathogens, the real-world bioaerosol concentration can be facilely evaluated by the HAFM-based ATP assay. This work thus not only provides a feasible strategy to fabricate air filter membranes for efficient microbial collection and enrichment but also sheds light on designing advanced protocols for real-time detection of bioaerosols in the field.

Concentrating viable airborne pathogens using a virtual impactor with a compact water-based condensation air sampler

Pathogens can be collected from air and detected in samples by many methods. However, merely detecting pathogens does not answer whether they can spread disease. To fully assess health risks from exposure to airborne pathogens, the infectivity of those agents must be assessed. Air samplers which operate by growing particles through water vapor condensation and subsequently collecting them into a liquid medium have proven effective at conserving the viability of microorganisms. We present a study that assessed performance improvement of one such sampler, BioSpot-GEM™, gained by augmenting it with an upstream virtual impactor (VI) designed to concentrate particles in aerosols. We demonstrate that such an integrated unit improved the collection of live Escherichia coli by a median Concentration Factor (C F ) of 1.59 and increased the recovery of viable human coronavirus OC43 (OC43) by a median C F of 12.7 as compared to the sampler without the VI. Our results also show that OC43 can be concentrated in this way without significant loss of infectivity. We further present that the small BioSpot-GEM™ bioaerosol sampler can collect live E. coli at an efficiency comparable to the larger BioSpot-VIVAS™ bioaerosol sampler. Our analyses show potential benefits toward improving the collection of viable pathogens from the air using a more portable water-based condensation air sampler while also highlighting challenges associated with using a VI with concentrated bioaerosols. This work can aid further investigation of VI usage to improve the collection of pathogens from air ultimately to better characterize health risks associated with airborne pathogen exposures.

DATIV-Remote Enhancement of Smart Aerosol Measurement System Using Raspberry Pi-Based Distributed Sensors

Enclosed public spaces are hotspots for airborne disease transmission. To measure and maintain indoor air quality in terms of airborne transmission, an open source, low cost and distributed array of particulate matter sensors was developed and named Dynamic Aerosol Transport for Indoor Ventilation, or DATIV, system. This system can use multiple particulate matter sensors (PMSs) simultaneously and can be remotely controlled using a Raspberry Pi-based operating system. The data acquisition system can be easily operated using the GUI within any common browser installed on a remote device such as a PC or smartphone with a corresponding IP address. The software architecture and validation measurements are presented together with possible future developments.

Reducing airborne transmissible diseases in perioperative environments

The COVID-19 pandemic has transformed our understanding of aerosol transmissible disease and the measures required to minimise transmission. Anaesthesia providers are often in close proximity to patients and other hospital staff for prolonged periods while working in operating and procedure rooms. Although enhanced ventilation provides some protection from aerosol transmissible disease in these work areas, close proximity and long duration of exposure have the opposite effect. Surgical masks provide only minimal additional protection. Surgical patients are also at risk from viral and bacterial aerosols. Despite having recently experienced the most significant pandemic in 100 yr, we continue to lack adequate understanding of the true risks encountered from aerosol transmissible diseases in the operating room, and the best course of action to protect patients and healthcare workers from them in the future. Nevertheless, hospitals can take specific actions now by providing respirators for routine use, encouraging staff to utilise respirators routinely, establishing triggers for situations that require respirator use, educating staff concerning the prevention of aerosol transmissible diseases, and providing portable air purifiers for perioperative spaces with low levels of ventilation.

Protective face mask: an effective weapon against SARS-CoV-2 with controlled environmental pollution

Masks are face coverings that give protection from infectious agents, airborne pathogens, bacteria, viruses, surgical fog, dust, and other chemical hazards by acting as a barrier between the wearer and the environment. In the COVID-19 pandemic, this major personal protective equipment's became essential part of our daily life. The aim of this review is to analyze and discuss the different types of masks with their pros and cons, manufacturing procedures, evaluation criteria, and application with some of the sterilization process for reuse and smart mask. The review used a thorough examination of the literature to analyze the preventive effects of surgical, N95, smart mask, and potential environmental damage from those masks. Several studies and evidence were also examined to understand the efficiency of different mask on different environment. N95 respirators are capable of filtering out non-oil-based 95% air-born particles, and surgical masks act as a protective barrier between the wearer and the environment. The application of spoon bond and melt blown techniques in the fabrication process of those masks improves their protective nature and makes them lightweight and comfortable. But the high demand and low supply forced users to reuse and extend their use after sterilizations, even though those masks are recommended to be used once. Universal masking in the SARS-COV-2 pandemic increased the chance of environmental pollution, so the application of smart masks became essential because of their high protection power and self-sterilizing and reusing capabilities.

Antipathogenic Applications of Copper Nanoparticles in Air Filtration Systems

The COVID-19 pandemic has underscored the critical need for effective air filtration systems in healthcare environments to mitigate the spread of viral and bacterial pathogens. This study explores the utilization of copper nanoparticle-coated materials for air filtration, offering both antiviral and antimicrobial properties. Highly uniform spherical copper oxide nanoparticles (~10 nm) were synthesized via a spinning disc reactor and subsequently functionalized with carboxylated ligands to ensure colloidal stability in aqueous solutions. The functionalized copper oxide nanoparticles were applied as antipathogenic coatings on extruded polyethylene and melt-blown polypropylene fibers to assess their efficacy in air filtration applications. Notably, Type IIR medical facemasks incorporating the copper nanoparticle-coated polyethylene fibers demonstrated a >90% reduction in influenza virus and SARS-CoV-2 within 2 h of exposure. Similarly, heating, ventilation, and air conditioning (HVAC) filtration pre- (polyester) and post (polypropylene)-filtration media were functionalised with the copper nanoparticles and exhibited a 99% reduction in various viral and bacterial strains, including SARS-CoV-2, Pseudomonas aeruginosa, Acinetobacter baumannii, Salmonella enterica, and Escherichia coli. In both cases, this mitigates not only the immediate threat from these pathogens but also the risk of biofouling and secondary risk factors. The assessment of leaching properties confirmed that the copper nanoparticle coatings remained intact on the polymeric fiber surfaces without releasing nanoparticles into the solution or airflow. These findings highlight the potential of nanoparticle-coated materials in developing biocompatible and environmentally friendly air filtration systems for healthcare settings, crucial in combating current and future pandemic threats.

Molecular detection of SARS-CoV-2 and other respiratory viruses in saliva and classroom air: a two winters tale

OBJECTIVES

To compare the prevalence of SARS-CoV-2 and other respiratory viruses in saliva and bioaerosols between two winters and to model the probability of virus detection in classroom air for different viruses.

METHODS

We analysed saliva, air, and air cleaner filter samples from studies conducted in two Swiss secondary schools (students aged 14-17 years) over 7 weeks during the winters of 2021/22 and 2022/23. Two bioaerosol sampling devices and high efficiency particulate air (HEPA) filters from air cleaners were used to collect airborne virus particles in four classrooms. Daily bioaerosol samples were pooled for each sampling device before PCR analysis of a panel of 19 respiratory viruses and viral subtypes. The probability of detection of airborne viruses was modelled using an adjusted Bayesian logistic regression model.

RESULTS

Three classes (58 students) participated in 2021/22, and two classes (38 students) in 2022/23. During winter 2021/22, SARS-CoV-2 dominated in saliva (19 of 21 positive samples) and bioaerosols (9 of 10). One year later, there were 50 positive saliva samples, mostly influenza B, rhinovirus, and adenovirus, and two positive bioaerosol samples, one rhinovirus and one adenovirus. The weekly probability of airborne detection was 34% (95% credible interval [CrI] 22-47%) for SARS-CoV-2 and 10% (95% CrI 5-16%) for other respiratory viruses.

DISCUSSION

There was a distinct shift in the distribution of respiratory viruses from SARS-CoV-2 during the omicron wave to other respiratory viruses one year later. SARS-CoV-2 is more likely to be detected in the air than other endemic respiratory viruses, possibly reflecting differences in viral characteristics and the composition of virus-carrying particles that facilitate airborne long-range transmission.

Rapid and on-site wireless immunoassay of respiratory virus aerosols via hydrogel-modulated resonators

Rapid and accurate detection of respiratory virus aerosols is highlighted for virus surveillance and infection control. Here, we report a wireless immunoassay technology for fast (within 10 min), on-site (wireless and battery-free), and sensitive (limit of detection down to fg/L) detection of virus antigens in aerosols. The wireless immunoassay leverages the immuno-responsive hydrogel-modulated radio frequency resonant sensor to capture and amplify the recognition of virus antigen, and flexible readout network to transduce the immuno bindings into electrical signals. The wireless immunoassay achieves simultaneous detection of respiratory viruses such as severe acute respiratory syndrome coronavirus 2, influenza A H1N1 virus, and respiratory syncytial virus for community infection surveillance. Direct detection of unpretreated clinical samples further demonstrates high accuracy for diagnosis of respiratory virus infection. This work provides a sensitive and accurate immunoassay technology for on-site virus detection and disease diagnosis compatible with wearable integration.

Contribution of Particulates to Airborne Disease Transmission and Severity: A Review

The emergence of coronavirus disease 2019 (COVID-19) has catalyzed great interest in the spread of airborne pathogens. Airborne infectious diseases are classified into viral, bacterial, and fungal infections. Environmental factors can elevate their transmission and lethality. Air pollution has been reported as the leading environmental cause of disease and premature death worldwide. Notably, ambient particulates of various components and sizes are harmful pollutants. There are two prominent health effects of particles in the atmosphere: (1) particulate matter (PM) penetrates the respiratory tract and adversely affects health, such as heart and respiratory diseases; and (2) bioaerosols of particles act as a medium for the spread of pathogens in the air. Particulates contribute to the occurrence of infectious diseases by increasing vulnerability to infection through inhalation and spreading disease through interactions with airborne pathogens. Here, we focus on the synergistic effects of airborne particulates on infectious disease. We outline the concepts and characteristics of bioaerosols, from their generation to transformation and circulation on Earth. Considering that microorganisms coexist with other particulates as bioaerosols, we investigate studies examining respiratory infections associated with airborne PM. Furthermore, we discuss four factors (meteorological, biological, physical, and chemical) that may impact the influence of PM on the survival of contagious pathogens in the atmosphere. Our review highlights the significant role of particulates in supporting the transmission of infectious aerosols and emphasizes the need for further research in this area.

Maternal and Newborn Outcomes of SARS-CoV-2/COVID-19 and Pregnancy: Parallels and Contrasts with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome

Purpose of Review

Our review aims to compare and contrast Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and SARS-CoV-2/COVID-19's impact on maternal and neonatal outcomes. We have made significant progress in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome prevention and treatment over the last few decades. Drawing on empirical evidence with past public health crises can offer valuable insights into dealing with current and future pandemics. Therefore, it is imperative to conduct a comparative analysis of the resemblances and disparities existing between Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and SARS-CoV-2/COVID-19.This research endeavor represents a pioneering and all-encompassing examination, aiming to discern and comprehend the parallels and contrasts in the respective impacts of SARS-CoV-2 and Human Immunodeficiency Virus on pregnancy.

Recent Findings

Based on the current evidence, there is no indication that pregnancy increases women's susceptibility to acquiring Human Immunodeficiency Virus or SARS-CoV-2. Nevertheless, the state of being pregnant was correlated with the worsening of diseases and their progression. Both Human Immunodeficiency Virus and SARS-CoV-2 pose increased risks of maternal mortality and several obstetric complications, including premature birth and pre-eclampsia. While the vertical transmission of Human Immunodeficiency Virus is well-established, a comprehensive understanding of the vertical transmission of SARS-CoV-2 remains elusive, emphasizing the need for further investigations. Initial data suggest low SARS-CoV-2 vertical transmission rates in the setting of proper preventative interventions and universal screening. A cesarean delivery could reduce the risk of mother-to-child transmission in Human Immunodeficiency Virus-infected women with high viral loads or poor adherence to antiretroviral therapy (ART). However, it did not offer additional protection for Human Immunodeficiency Virus-infected women who adhered to Adherence to Antiretroviral Therapy or those with COVID-19. Human Immunodeficiency Virus and SARS-CoV-2 were linked to neonatal complications such as stillbirth, low birth weight, and neonatal intensive care unit (ICU) admissions. The universal testing of both pregnant patients and neonates is an effective strategy to prevent the spread and complications of both Human Immunodeficiency Virus and SARS-CoV-2. Human Immunodeficiency Virus control largely relies on preventing vertical transmission and medications during pregnancy and postpartum, whereas safety behaviors and vaccines have proven effective in preventing SARS-CoV-2 vertical transmissions.

Summary

This review aims to compare and contrast the impact of Human Immunodeficiency Virus and SARS-CoV-2 on pregnancy outcomes, vertical transmissions, delivery modalities, neonatal outcomes, and clinical management. SARS-CoV-2 and Human Immunodeficiency Virus were associated with significant obstetric-related complications, making close clinical monitoring and preparation essential. Integration of SARS-CoV-2/COVID-19 management with reproductive health services is crucial to ensuring maternal and neonatal outcomes. Our review is not only the first to establish a groundwork for the current state of knowledge and its clinical implications on this topic, but it also sheds new insights for future research directions.Comparing Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and SARS-CoV-2 in terms of their impact on maternal and neonatal outcomes provides valuable insights despite their differences. Leveraging Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome research can help understand SARS-CoV-2 effects on pregnancy. Both infections pose risks to pregnant individuals and their fetuses, leading to increased maternal mortality and complications. Identifying common patterns and risk factors can improve clinical management for pregnant individuals with SARS-CoV-2. While a direct observational study for this comparison may not be feasible, comparing with Human Immunodeficiency Virus offers an ethical and practical approach. However, specific studies on SARS-CoV-2 are still necessary to gather detailed data on maternal and fetal outcomes.

Air Cleaners and Respiratory Infections in Schools: A Modeling Study Based on Epidemiologic, Environmental, and Molecular Data

Background

Using a multiple-measurement approach, we examined the real-world effectiveness of portable HEPA air filtration devices (air cleaners) in a school setting.

Methods

We collected data over 7 weeks during winter 2022/2023 in 2 Swiss secondary school classes: environmental (CO2, particle concentrations), epidemiologic (absences related to respiratory infections), audio (coughing), and molecular (bioaerosol and saliva samples). Using a crossover design, we compared particle concentrations, coughing, and risk of infection with and without air cleaners.

Results

All 38 students participated (age, 13-15 years). With air cleaners, mean particle concentration decreased by 77% (95% credible interval, 63%-86%). There were no differences in CO2 levels. Absences related to respiratory infections were 22 without air cleaners vs 13 with them. Bayesian modeling suggested a reduced risk of infection, with a posterior probability of 91% and a relative risk of 0.73 (95% credible interval, 0.44-1.18). Coughing also tended to be less frequent (posterior probability, 93%), indicating that fewer symptomatic students were in class. Molecular analysis detected mainly non-SARS-CoV-2 viruses in saliva (50/448 positive) but not in bioaerosols (2/105) or on the HEPA filters of the air cleaners (4/160). The molecular detection rate in saliva was similar with and without air cleaners. Spatiotemporal analysis of positive saliva samples identified several likely transmissions.

Conclusions

Air cleaners improved air quality and showed potential benefits in reducing respiratory infections. Airborne detection of non-SARS-CoV-2 viruses was rare, suggesting that these viruses may be more difficult to detect in the air. Future studies should examine the importance of close contact and long-range transmission and the cost-effectiveness of using air cleaners.

Development and evaluation of an online monitoring single-particle optical particle counter with polarization detection

We developed a single-particle optical particle counter with polarization detection (SOPC) for the real-time measurement of the optical size and depolarization ratio (defined as the ratio of the vertical component to the parallel component of backward scattering) of atmospheric particles, the polarization ratio (DR) value can reflect the irregularity of the particles. The SOPC can detect aerosol particles with size larger than 500 nm and the maximum particle count rate reaches ∼1.8 × 105 particles per liter. The SOPC uses a modulated polarization laser to measure the optical size of particles according to forward scattering signal and the DR value of the particles by backward S and P signal components. The sampling rate of the SOPC was 106 #/(sec·channel), and all the raw data were processed online. The calibration curve was obtained by polystyrene latex spheres with sizes of 0.5-10 µm, and the average relative deviation of measurement was 3.96% for sub 3 µm particles. T-matrix method calculations showed that the DR value of backscatter light at 120° could describe the variations in the aspect ratio of particles in the above size range. We performed insitu observations for the evaluation of the SOPC, the mass concentration constructed by the SOPC showed good agreement with the PM2.5 measurements in a nearby state-controlled monitoring site. This instrument could provide useful data for source appointment and regulations against air pollution.

The Occupational and Environmental Hazards of Uncovered Toilets

ABSTRACT

Substantial evidence demonstrates that plumes from uncovered toilets potentially expose nurses and other health care workers to aerosols containing infectious agents and hazardous drugs, including antineoplastic drugs. Most hospitals in the United States utilize flushometer-type toilets, which operate under high pressure and do not have a permanently attached closure or lid, which is known to reduce the aerosols generated by flushing. This article aims to raise awareness among nurses of the potential exposure risks associated with toilet plume aerosols, so they can educate other health care workers and take part in initiatives to address these risks.

The Efficacy of an Extraoral Suction Apparatus on Reduction of Splatter Contamination during Impacted Lower Third Molar Surgical Procedure: An Observational Study

Background

The COVID-19 pandemic has affected the delivery of dental care globally. Air contamination during aerosol and splatter-generating procedures is of great concern to dental healthcare provider during these times. Extra oral suction (EOS) apparatus has been shown to be effective in preventing infection by control of aerosol. But very limited data is available regarding the efficacy of the apparatus in preventing splatter contamination.

Objectives of the Study

To assess the efficacy of EOS apparatus in reducing frequency and mean intensity of splatter contamination at clinician, assistant, patient sites during lower third molar surgical procedures.

Materials and Methods

Patients who required surgical removal of an impacted lower third molar were divided into two groups (EOS and non-EOS) with 20 patients each. Universal indicating paper (UIP) was placed in specific locations on the surgeon, patient, and assistant. Colour changes after the settling of splatter on the UIP were analyzed to calculate the percentage intensity of splatter contamination.

Results

The use of an EOS device has shown an overall reduction in the total number of contaminated sites, with a difference of 6.36%. Surgeon, patient, and assistant sites showed reductions of 6.25, 10%, and 1.66%, respectively. The apparatus has showed statistically significant reduction of splatter frequency and intensity at the patient's chest and left shoulder regions respectively, during surgical removal of the impacted 48.

Conclusion

The magnitude of splatter contamination during minor dentoalveolar surgical procedures is inevitable. Therefore, to achieve a better working environment, usage of an EOS apparatus is advocated.

Effect of face masks on dyspnea perception, cardiopulmonary parameters, and facial temperature in healthy adults

Respiratory droplets, naturally produced during expiration, can transmit pathogens from infected individuals. Wearing a face mask is crucial to prevent such transmission, yet the perception of dyspnea and uncomfortable breathing remains a common concern, particularly during epidemics. The aim of this study was to investigate the impact of face mask use on the perception of dyspnea, cardiopulmonary parameters, and facial temperature during physical activity. A randomized crossover study was conducted on healthy adults at a physiology laboratory located in the Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia, in November 2022. Participants underwent five stages of physical exercise tests based on the Bruce Protocol under three conditions: without any face mask (control), wearing a surgical mask, and an N95 mask, forming the study's main groups. Dyspnea perception (measured by the Modified Borg Dyspnea Scale), cardiopulmonary parameters (heart rate, oxygen saturation, respiratory rate, blood pressure, and mean arterial pressure) and facial temperature were measured before the exercise test (pre-workout), at the end of stage 1, 2, 3, 4, 5, and after the whole exercise test (post-workout). A two-way repeated measures ANOVA was conducted, considering two factors: the type of mask (control, surgical mask, N95 mask) and the various stages of the exercise test. A total of 36 healthy adults were included in the study. We found that dyspnea perception was much worse in the N95 mask group, particularly during vigorous exercise. There was no significant difference between groups in cardiopulmonary parameters. However, participants wearing N95 had a greater supralabial temperature than those wearing surgical masks or no mask at all. It is recommended to undertake a more in-depth evaluation of cardiopulmonary physiological measures.

Bioaerosols in the coastal region of Qingdao: Community diversity, impact factors and synergistic effect

Atmospheric bioaerosols are influenced by multiple factors, including physical, chemical, and biotic interactions, and pose a significant threat to the public health and the environment. The nonnegligible truth however is that the primary driver of the changes in bioaerosol community diversity remains unknown. In this study, putative biological association (PBA) was obtained by constructing an ecological network. The relationship between meteorological conditions, atmospheric pollutants, water-soluble inorganic ions, PBA and bioaerosol community diversity was analyzed using random forest regression (RFR)-An ensemble learning algorithm based on a decision tree that performs regression tasks by constructing multiple decision trees and integrating the predicted results, and the contribution of different rich species to PBA was predicted. The species richness, evenness and diversity varied significantly in different seasons, with the highest in summer, followed by autumn and spring, and was lowest in winter. The RFR suggested that the explanation rate of alpha diversity increased significantly from 73.74 % to 85.21 % after accounting for the response of the PBA to diversity. The PBA, temperature, air pollution, and marine source air masses were the most crucial factors driving community diversity. PBA, particularly putative positive association (PPA), had the highest significance in diversity. We found that under changing external conditions, abundant taxa tend to cooperate to resist external pressure, thereby promoting PPA. In contrast, rare taxa were more responsive to the putative negative association because of their sensitivity to environmental changes. The results of this research provided scientific advance in the understanding of the dynamic and temporal changes in bioaerosols, as well as support for the prevention and control of microbial contamination of the atmosphere.

COVID-19: An overview on possible transmission ways, sampling matrices and diagnosis

COVID-19 is an RNA virus belonging to the SARS family of viruses and includes a wide range of symptoms along with effects on other body organs in addition to the respiratory system. The high speed of transmission, severe complications, and high death rate caused scientists to focus on this disease. Today, many different investigation types are performed on COVID-19 from various points of view in the literature. This review summarizes most of them to provide a useful guideline for researchers in this field. After a general introduction, this review is divided into three parts. In the first one, various transmission ways COVID-19 are classified and explained in detail. The second part reviews the used biological samples for the detection of virus and the final section describes the various methods reported for the diagnosis of COVID-19 in various biological matrices.

Frequency, kinetics and determinants of viable SARS-CoV-2 in bioaerosols from ambulatory COVID-19 patients infected with the Beta, Delta or Omicron variants

Airborne transmission of SARS-CoV-2 aerosol remains contentious. Importantly, whether cough or breath-generated bioaerosols can harbor viable and replicating virus remains largely unclarified. We performed size-fractionated aerosol sampling (Andersen cascade impactor) and evaluated viral culturability in human cell lines (infectiousness), viral genetics, and host immunity in ambulatory participants with COVID-19. Sixty-one percent (27/44) and 50% (22/44) of participants emitted variant-specific culture-positive aerosols <10μm and <5μm, respectively, for up to 9 days after symptom onset. Aerosol culturability is significantly associated with lower neutralizing antibody titers, and suppression of transcriptomic pathways related to innate immunity and the humoral response. A nasopharyngeal Ct <17 rules-in ~40% of aerosol culture-positives and identifies those who are probably highly infectious. A parsimonious three transcript blood-based biosignature is highly predictive of infectious aerosol generation (PPV > 95%). There is considerable heterogeneity in potential infectiousness i.e., only 29% of participants were probably highly infectious (produced culture-positive aerosols <5μm at ~6 days after symptom onset). These data, which comprehensively confirm variant-specific culturable SARS-CoV-2 in aerosol, inform the targeting of transmission-related interventions and public health containment strategies emphasizing improved ventilation.

Indoor air humidity revisited: Impact on acute symptoms, work productivity, and risk of influenza and COVID-19 infection

Recent epidemiological and experimental findings reconfirm that low indoor air humidity (dry air) increases the prevalence of acute eye and airway symptoms in offices, result in lower mucociliary clearance in the airways, less efficient immune defense, and deteriorate the work productivity. New epidemiological and experimental research also support that the environmental conditions for the risk of infection of influenza and COVID-19 virus is lowest in the Goldilocks zone of 40-60% relative humidity (RH) by decrease of the airways' susceptibility, which can be elevated by particle exposure. Furthermore, low RH increases the generation of infectious virus laden aerosols exhaled from infected people. In general, elevation of the indoor air humidity from dry air increases the health of the airways concomitantly with lower viability of infectious virus. Thus, the negative effects of ventilation with dry outdoor air (low absolute air humidity) should be assessed according to 1) weakened health and functionality of the airways, 2) increased viability and possible increased transmissibility of infectious virus, and 3) evaporation of virus containing droplets to dry out to droplet nuclei (also possible at high room temperature), which increases their floating time in the indoor air. The removal of acid-containing ambient aerosols from the indoor air by filtration increases pH, viability of infectious viruses, and the risk of infection, which synergistically may further increase by particle exposure. Thus, the dilution of indoor air pollutants and virus aerosols by dry outdoor air ventilation should be assessed and compared with the beneficial health effects by control of the center zone of 40-60% RH, an essential factor for optimal functionality of the airways, and with the additional positive impact on acute symptoms, work productivity, and reduced risk of infection.

Nasopharyngeal angiotensin converting enzyme 2 (ACE2) expression as a risk-factor for SARS-CoV-2 transmission in concurrent hospital associated outbreaks

BACKGROUND

Widespread human-to-human transmission of the severe acute respiratory syndrome coronavirus two (SARS-CoV-2) stems from a strong affinity for the cellular receptor angiotensin converting enzyme two (ACE2). We investigate the relationship between a patient's nasopharyngeal ACE2 transcription and secondary transmission within a series of concurrent hospital associated SARS-CoV-2 outbreaks in British Columbia, Canada.

METHODS

Epidemiological case data from the outbreak investigations was merged with public health laboratory records and viral lineage calls, from whole genome sequencing, to reconstruct the concurrent outbreaks using infection tracing transmission network analysis. ACE2 transcription and RNA viral load were measured by quantitative real-time polymerase chain reaction. The transmission network was resolved to calculate the number of potential secondary cases. Bivariate and multivariable analyses using Poisson and Negative Binomial regression models was performed to estimate the association between ACE2 transcription the number of SARS-CoV-2 secondary cases.

RESULTS

The infection tracing transmission network provided n = 76 potential transmission events across n = 103 cases. Bivariate comparisons found that on average ACE2 transcription did not differ between patients and healthcare workers (P = 0.86). High ACE2 transcription was observed in 98.6% of transmission events, either the primary or secondary case had above average ACE2. Multivariable analysis found that the association between ACE2 transcription (log2 fold-change) and the number of secondary transmission events differs between patients and healthcare workers. In health care workers Negative Binomial regression estimated that a one-unit change in ACE2 transcription decreases the number of secondary cases (β = -0.132 (95%CI: -0.255 to -0.0181) adjusting for RNA viral load. Conversely, in patients a one-unit change in ACE2 transcription increases the number of secondary cases (β = 0.187 (95% CI: 0.0101 to 0.370) adjusting for RNA viral load. Sensitivity analysis found no significant relationship between ACE2 and secondary transmission in health care workers and confirmed the positive association among patients.

CONCLUSION

Our study suggests that ACE2 transcription has a positive association with SARS-CoV-2 secondary transmission in admitted inpatients, but not health care workers in concurrent hospital associated outbreaks, and it should be further investigated as a risk-factor for viral transmission.

Aeromicrobiology: A global review of the cycling and relationships of bioaerosols with the atmosphere

Airborne microorganisms and biological matter (bioaerosols) play a key role in global biogeochemical cycling, human and crop health trends, and climate patterns. Their presence in the atmosphere is controlled by three main stages: emission, transport, and deposition. Aerial survival rates of bioaerosols are increased through adaptations such as ultra-violet radiation and desiccation resistance or association with particulate matter. Current research into modern concerns such as climate change, global gene transfer, and pathogenicity often neglects to consider atmospheric involvement. This comprehensive review outlines the transpiring of bioaerosols across taxa in the atmosphere, with significant focus on their interactions with environmental elements including abiotic factors (e.g., atmospheric composition, water cycle, and pollution) and events (e.g., dust storms, hurricanes, and wildfires). The aim of this review is to increase understanding and shed light on needed research regarding the interplay between global atmospheric phenomena and the aeromicrobiome. The abundantly documented bacteria and fungi are discussed in context of their cycling and human health impacts. Gaps in knowledge regarding airborne viral community, the challenges and importance of studying their composition, concentrations and survival in the air are addressed, along with understudied plant pathogenic oomycetes, and archaea cycling. Key methodologies in sampling, collection, and processing are described to provide an up-to-date picture of ameliorations in the field. We propose optimization to microbiological methods, commonly used in soil and water analysis, that adjust them to the context of aerobiology, along with other directions towards novel and necessary advancements. This review offers new perspectives into aeromicrobiology and calls for advancements in global-scale bioremediation, insights into ecology, climate change impacts, and pathogenicity transmittance.

Reduction of acute respiratory infections in day-care by non-pharmaceutical interventions: a narrative review

Objective

Children who start in day-care have 2-4 times as many respiratory infections compared to children who are cared for at home, and day-care staff are among the employees with the highest absenteeism. The extensive new knowledge that has been generated in the COVID-19 era should be used in the prevention measures we prioritize. The purpose of this narrative review is to answer the questions: Which respiratory viruses are the most significant in day-care centers and similar indoor environments? What do we know about the transmission route of these viruses? What evidence is there for the effectiveness of different non-pharmaceutical prevention measures?

Design

Literature searches with different terms related to respiratory infections in humans, mitigation strategies, viral transmission mechanisms, and with special focus on day-care, kindergarten or child nurseries, were conducted in PubMed database and Web of Science. Searches with each of the main viruses in combination with transmission, infectivity, and infectious spread were conducted separately supplemented through the references of articles that were retrieved.

Results

Five viruses were found to be responsible for ≈95% of respiratory infections: rhinovirus, (RV), influenza virus (IV), respiratory syncytial virus (RSV), coronavirus (CoV), and adenovirus (AdV). Novel research, emerged during the COVID-19 pandemic, suggests that most respiratory viruses are primarily transmitted in an airborne manner carried by aerosols (microdroplets).

Conclusion

Since airborne transmission is dominant for the most common respiratory viruses, the most important preventive measures consist of better indoor air quality that reduces viral concentrations and viability by appropriate ventilation strategies. Furthermore, control of the relative humidity and temperature, which ensures optimal respiratory functionality and, together with low resident density (or mask use) and increased time outdoors, can reduce the occurrence of respiratory infections.

Study of aerosol dispersion and control in dental practice

OBJECTIVES

In this study, we investigated the dispersion patterns of aerosols and droplets in dental clinics and developed a suction device to evaluate its effectiveness in reducing aerosols during dental procedures.

MATERIALS AND METHODS

Firstly, the continuous images of oral aerosols and droplets were photographed with a high-speed camera, and the trajectories of these particles were recognized and processed by Image J to determine key parameters affecting particle dispersion: diffusion velocity, distance, and angle. Secondly, based on the parameter data, the flow field of aerosol particles around the oral cavity was simulated using computational fluid dynamics (CFD), and the flow field under adsorption conditions was simulated to demonstrate the aerodynamic characteristics and capture efficiencies of the single-channel and three-channel adsorption ports at different pressures. Finally, according to the simulated data, a three-channel suction device was developed, and the capture efficiency of the device was tested by the fluorescein tracer method.

RESULTS

The dispersion experimental data showed that aerosol particles' maximum diffusion velocity, distance, and angle were 6.2 m/s, 0.55 m, and 130°, respectively. The simulated aerosol flow-field distribution was consistent with the aerosol dispersion patterns. The adsorption simulation results showed that the outlet flow rate of single-channel adsorption was 184.5 L/s at - 350 Pa, and the aerosol capture efficiency could reach 79.4%. At - 350 Pa and - 150 Pa, the outlet flow rate of three-channel adsorption was 228.9 L/s, and the capture efficiency was 99.23%. The adsorption experimental data showed that the capture efficiency of three-channel suction device was 97.71%.

CONCLUSIONS

A three-channel suction device was designed by simulations and experiments, which can capture most aerosols in the dental clinic and prevent them from spreading.

CLINICAL RELEVANCE

Using three-channel suction devices during oral treatment effectively reduces the spread of oral aerosols, which is essential to prevent the spread of epidemics and ensure the health and safety of patients and dental staff.

Airborne transmission risks of tuberculosis and COVID-19 in schools in South Africa, Switzerland, and Tanzania: Modeling of environmental data

The COVID-19 pandemic renewed interest in airborne transmission of respiratory infections, particularly in congregate indoor settings, such as schools. We modeled transmission risks of tuberculosis (caused by Mycobacterium tuberculosis, Mtb) and COVID-19 (caused by SARS-CoV-2) in South African, Swiss and Tanzanian secondary schools. We estimated the risks of infection with the Wells-Riley equation, expressed as the median with 2.5% and 97.5% quantiles (credible interval [CrI]), based on the ventilation rate and the duration of exposure to infectious doses (so-called quanta). We computed the air change rate (ventilation) using carbon dioxide (CO2) as a tracer gas and modeled the quanta generation rate based on reported estimates from the literature. The share of infectious students in the classroom is determined by country-specific estimates of pulmonary TB. For SARS-CoV-2, the number of infectious students was estimated based on excess mortality to mitigate the bias from country-specific reporting and testing. Average CO2 concentration (parts per million [ppm]) was 1,610 ppm in South Africa, 1,757 ppm in Switzerland, and 648 ppm in Tanzania. The annual risk of infection for Mtb was 22.1% (interquartile range [IQR] 2.7%-89.5%) in South Africa, 0.7% (IQR 0.1%-6.4%) in Switzerland, and 0.5% (IQR 0.0%-3.9%) in Tanzania. For SARS-CoV-2, the monthly risk of infection was 6.8% (IQR 0.8%-43.8%) in South Africa, 1.2% (IQR 0.1%-8.8%) in Switzerland, and 0.9% (IQR 0.1%-6.6%) in Tanzania. The differences in transmission risks primarily reflect a higher incidence of SARS-CoV-2 and particularly prevalence of TB in South Africa, but also higher air change rates due to better natural ventilation of the classrooms in Tanzania. Global comparisons of the modeled risk of infectious disease transmission in classrooms can provide high-level information for policy-making regarding appropriate infection control strategies.

Air cleaners and respiratory infections in schools: A modeling study using epidemiological, environmental, and molecular data

Background

Using a multiple-measurement approach, we examined the real-world effectiveness of portable HEPA-air filtration devices (air cleaners) in a school setting.

Methods

We collected environmental (CO2, particle concentrations), epidemiological (absences related to respiratory infections), audio (coughing), and molecular data (bioaerosol and saliva samples) over seven weeks during winter 2022/2023 in two Swiss secondary school classes. Using a cross-over study design, we compared particle concentrations, coughing, and the risk of infection with vs without air cleaners.

Results

All 38 students (age 13-15 years) participated. With air cleaners, mean particle concentration decreased by 77% (95% credible interval 63%-86%). There were no differences in CO2 levels. Absences related to respiratory infections were 22 without vs 13 with air cleaners. Bayesian modeling suggested a reduced risk of infection, with a posterior probability of 91% and a relative risk of 0.73 (95% credible interval 0.44-1.18). Coughing also tended to be less frequent (posterior probability 93%). Molecular analysis detected mainly non-SARS-CoV-2 viruses in saliva (50/448 positive), but not in bioaerosols (2/105 positive) or HEPA-filters (4/160). The detection rate was similar with vs without air cleaners. Spatiotemporal analysis of positive saliva samples identified several likely transmissions.

Conclusions

Air cleaners improved air quality, showed a potential benefit in reducing respiratory infections, and were associated with less coughing. Airborne detection of non-SARS-CoV-2 viruses was rare, suggesting that these viruses may be more difficult to detect in the air. Future studies should examine the importance of close contact and long-range transmission, and the cost-effectiveness of using air cleaners.