Transmission by super-spreading event of pandemic A/H1N1 2009 influenza during road and train travel

A systematic approach to microbial forensics

The coronavirus disease 2019 pandemic accelerated developments in biotechnology that underpin infection science. These advances present an opportunity to refresh the microbial forensic toolkit. Integration of novel analytical techniques with established forensic methods will speed up acquisition of evidence and better support lines of enquiry. A critical part of any such investigation is demonstration of a robust causal relationship and attribution of responsibility for an incident. In the wider context of a formal investigation into agency, motivation and intent, the quick and efficient assembly of microbiological evidence sets the tone and tempo of the entire investigation. Integration of established and novel analytical techniques from infection science into a systematic approach to microbial forensics will therefore ensure that major perspectives are correctly used to frame and shape the evidence into a clear narrative, while recognizing that forensic hypothesis generation, testing and refinement comprise an iterative process. Development of multidisciplinary training exercises that use this approach will enable translation into practice and efficient implementation when the need arises.

Decay rate estimation of respiratory viruses in aerosols and on surfaces under different environmental conditions

Majority of the viral outbreaks are super-spreading events established within 2-10 h, dependent on a critical time interval for successful transmission between humans, which is governed by the decay rates of viruses. To evaluate the decay rates of respiratory viruses over a short span, we calculated their decay rate values for various surfaces and aerosols. We applied Bayesian regression and ridge regression and determined the best estimation for respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), severe acute respiratory syndrome coronavirus (SARS-CoV), middle east respiratory syndrome coronavirus (MERS-CoV), influenza viruses, and respiratory syncytial virus (RSV); the decay rate values in aerosols for these viruses were 4.83 ± 5.70, 0.40 ± 0.24, 0.11 ± 0.04, 2.43 ± 5.94, and 1.00 ± 0.50 h^-1, respectively. The highest decay rate values for each virus type differed according to the surface type. According to the model performance criteria, the Bayesian regression model was better for SARS-CoV-2 and influenza viruses, whereas ridge regression was better for SARS-CoV and MERS-CoV. A simulation using a better estimation will help us find effective non-pharmaceutical interventions to control virus transmissions.

Passenger flow analysis and emergency response simulation in a metro network using virus transmission model

OBJECTIVES

The potential virus in transportation facilities poses a serious risk to travelers. This research focus on the commuting by metro on the risk of the coronavirus disease 2019 (COVID-19). The main purpose is to explore the trajectory of virus transmission and the effectiveness of various control measures.

METHODS

A transmission model was established on the basis of the susceptible-infected-recovered (SIR) model, combined with the spatial and temporal characteristics of the metro passenger flow. The implementation effects of the emergency strategies were analyzed through a series of simulation experiments. The changes in passenger flow affected by the virus transmission were analyzed both under the single intervention condition of the disinfection or off-peak travel policy and their double interventions.

RESULTS

The results of the experiments show that disinfection and off-peak travel can effectively reduce the number of the infected people. To promote the disinfection is better than the off-peak travel strategy. The optimal solution is the combination of these two strategies, thereby reducing the infection rate in the stations effectively. In particular, it can reduce the number of potential infected people in high-traffic stations by 50%.

CONCLUSIONS

This study provides a scientific basis for the prevention of COVID-19 in the urban transportation system and the formulation of public emergency strategies. It can also be applied to other epidemic diseases such as the seasonal flu, for public health prevention.

What were the historical reasons for the resistance to recognizing airborne transmission during the COVID-19 pandemic?

The question of whether SARS-CoV-2 is mainly transmitted by droplets or aerosols has been highly controversial. We sought to explain this controversy through a historical analysis of transmission research in other diseases. For most of human history, the dominant paradigm was that many diseases were carried by the air, often over long distances and in a phantasmagorical way. This miasmatic paradigm was challenged in the mid to late 19th century with the rise of germ theory, and as diseases such as cholera, puerperal fever, and malaria were found to actually transmit in other ways. Motivated by his views on the importance of contact/droplet infection, and the resistance he encountered from the remaining influence of miasma theory, prominent public health official Charles Chapin in 1910 helped initiate a successful paradigm shift, deeming airborne transmission most unlikely. This new paradigm became dominant. However, the lack of understanding of aerosols led to systematic errors in the interpretation of research evidence on transmission pathways. For the next five decades, airborne transmission was considered of negligible or minor importance for all major respiratory diseases, until a demonstration of airborne transmission of tuberculosis (which had been mistakenly thought to be transmitted by droplets) in 1962. The contact/droplet paradigm remained dominant, and only a few diseases were widely accepted as airborne before COVID-19: those that were clearly transmitted to people not in the same room. The acceleration of interdisciplinary research inspired by the COVID-19 pandemic has shown that airborne transmission is a major mode of transmission for this disease, and is likely to be significant for many respiratory infectious diseases.

Time and spatially resolved tracking of the air quality in local public transport

As an indoor environment, public transport is subject to special conditions with many passengers in a comparatively small space. Therefore, both an efficient control of the climatic parameters and a good air exchange are necessary to avoid transmission and spread of respiratory diseases. However, in such a dynamic system it is practically impossible to determine pathogenic substances with the necessary temporal and spatial resolution, but easy-to-measure parameters allow the air quality to be assessed in a passenger compartment. Carbon dioxide has already proven to be a useful indicator, especially in environments with a high occupancy of people. Airborne particulate matter can also be an important aspect for assessing the air quality in an indoor space. Consequently, the time courses of temperature, relative humidity, carbon dioxide and particulate matter (PM₁₀) were tracked and evaluated in local public transport buses, trams and trains in the Brunswick/Hanover region. In all measurements, the climatic conditions were comfortable for the passengers. Carbon dioxide was strongly correlated with occupancy and has proven to be the most informative parameter. The PM₁₀ concentration, however, often correlated with the dynamics of people when getting on and off, but not with the occupancy. Sensors, equipped with integrated GPS, were installed in the passenger cabins and were found to be useful for recording location-related effects such as stops. The results of this study show that the online recording of simple parameters is a valuable tool for assessing air quality as a function of time, location and number of people. When the occupancy is high, a low carbon dioxide level indicates good ventilation, which automatically reduces the risk of infection. It is therefore recommended to take more advantage of low-cost sensors as a control for air conditioning systems in passenger cabins and for evaluations of the dynamics in public transport.

Impact of COVID-19 pandemic lockdown on the public transportation system and strategic plans to improve PT ridership: a review

The pandemic of coronavirus disease 2019 (COVID-19) has caused more than 198.03 million confirmed cases around the world, and nearly 31.65 million cases are reported in India as of 1^st August 2021. Though it is reported to have originated from one particular place, the COVID-19 is continuously spreading to various countries due to the movement of people in and around the world. For curbing the spread of the COVID-19 virus, many countries have implemented lockdown and restrictions on public mobility (except the essential goods travel) within various zones. Though this lockdown is going to limit the spread of the virus, at the same time it creates an adverse impact on the livelihood of the people and economy of the country. Despite the surge in infections, the governments of different countries have to ease out the lockdown and allow the mobility of people from one place to another place by public transportation (PT) system due to various reasons. Hence, the present study explores the impact of COVID-19 lockdown on the PT system and the post-lockdown policies implemented by various countries to improve the PT ridership. Further, the study also addresses various challenges to operate the PT system and the emergency relief plans proposed by various countries to make the PT system more sustainable by integrating it with active transport modes such as cycling and walking. The discussed ease-out plans might help the policymakers to design a case-specific plan for the effective and safe operation of the PT system post-lockdown.

Outdoor Transmission of SARS-CoV-2 and Other Respiratory Viruses: A Systematic Review

Background

While risk of outdoor transmission of respiratory viral infections is hypothesized to be low, there is limited data of SARS-CoV-2 transmission in outdoor compared to indoor settings.

Methods

We conducted a systematic review of peer-reviewed papers indexed in PubMed, EMBASE and Web of Science and pre-prints in Europe PMC through August 12 ^th, 2020 that described cases of human transmission of SARS-CoV-2. Reports of other respiratory virus transmission were included for reference.

Results

Five identified studies found that a low proportion of reported global SARS-CoV-2 infections have occurred outdoors (<10%) and the odds of indoor transmission was very high compared to outdoors (18.7 times; 95% CI 6.0, 57.9). Five studies described influenza transmission outdoors and two described adenovirus transmission outdoors. There was high heterogeneity in study quality and individual definitions of outdoor settings which limited our ability to draw conclusions about outdoor transmission risks. In general, factors such as duration and frequency of personal contact, lack of personal protective equipment and occasional indoor gathering during a largely outdoor experience were associated with outdoor reports of infection.

Conclusion

Existing evidence supports the wide-held belief that the the risk of SARS-CoV-2 transmission is lower outdoors but there are significant gaps in our understanding of specific pathways.

Impact of the COVID-19 pandemic on travel behavior in Istanbul: A panel data analysis

The COVID-19 pandemic, which was reported in early January 2020 in China and spread rapidly around the globe, will certainly remain as one of the most impactful disruptive events of the 21st century. To contain the spread of the virus while awaiting a vaccine, countries applied different approaches from simply giving advice on personal hygiene and applying progressive measures to total lockdown. This paper aims to investigate the impacts of the pandemic on travel behavior in Istanbul, Turkey, through a longitudinal panel study conducted in three phases during the early stages of the epidemic and pandemic. The paper reflects the travel behavior evolution during the development of the outbreak resulting from residents' self- regulation and governmental measures, distinguishing travel for commute, Social/Recreational/Leisure (SRL), and shopping activities, as well as use of different travel modes based on various socio-economic characteristics. Due to the application of the social distancing of at least 1.5 m, closure of numerous non-essential venues, encouraging teleworking and distance education, job losses and cancellation of all social gatherings in Istanbul between the second and third phase of our data collection, the transition in travel activity pattern and transport mobility appears to be quite extreme, particularly for commuting and SRL trips.

Escherichia coli, cattle and the propagation of disease

Several early models describing host–pathogen interaction have assumed that each individual host has approximately the same likelihood of becoming infected or of infecting others. More recently, a concept that has been increasingly emphasized in many studies is that for many infectious diseases, transmission is not homogeneous but highly skewed at the level of populations. In what became known as the ‘20/80 rule’, about 20% of the hosts in a population were found to contribute to about 80% of the transmission potential. These heterogeneities have been described for the interaction between many microorganisms and their human or animal hosts. Several epidemiological studies have reported transmission heterogeneities for Escherichia coli by cattle, a phenomenon with far-reaching agricultural, medical and public health implications. Focusing on E. coli as a case study, this paper will describe super-spreading and super-shedding by cattle, review the main factors that shape these transmission heterogeneities and examine the interface with human health. Escherichia coli super-shedding and super-spreading by cattle are shaped by microorganism-specific, cattle-specific and environmental factors. Understanding the factors that shape heterogeneities in E. coli dispersion by cattle and the implications for human health represent key components that are critical for targeted infection control initiatives.

Airborne biological hazards and urban transport infrastructure: current challenges and future directions

Exposure to airborne biological hazards in an ever expanding urban transport infrastructure and highly diverse mobile population is of growing concern, in terms of both public health and biosecurity. The existing policies and practices on design, construction and operation of these infrastructures may have severe implications for airborne disease transmission, particularly, in the event of a pandemic or intentional release of biological of agents. This paper reviews existing knowledge on airborne disease transmission in different modes of transport, highlights the factors enhancing the vulnerability of transport infrastructures to airborne disease transmission, discusses the potential protection measures and identifies the research gaps in order to build a bioresilient transport infrastructure. The unification of security and public health research, inclusion of public health security concepts at the design and planning phase, and a holistic system approach involving all the stakeholders over the life cycle of transport infrastructure hold the key to mitigate the challenges posed by biological hazards in the twenty-first century transport infrastructure.

The roles of transportation and transportation hubs in the propagation of influenza and coronaviruses: a systematic review

BACKGROUND

Respiratory viruses spread in humans across wide geographical areas in short periods of time, resulting in high levels of morbidity and mortality. We undertook a systematic review to assess the evidence that air, ground and sea mass transportation systems or hubs are associated with propagating influenza and coronaviruses.

METHODS

Healthcare databases and sources of grey literature were searched using pre-defined criteria between April and June 2014. Two reviewers screened all identified records against the protocol, undertook risk of bias assessments and extracted data using a piloted form. Results were analysed using a narrative synthesis.

RESULTS

Forty-one studies met the eligibility criteria. Risk of bias was high in the observational studies, moderate to high in the reviews and moderate to low in the modelling studies. In-flight influenza transmission was identified substantively on five flights with up to four confirmed and six suspected secondary cases per affected flight. Five studies highlighted the role of air travel in accelerating influenza spread to new areas. Influenza outbreaks aboard cruise ships affect 2-7% of passengers. Influenza transmission events have been observed aboard ground transport vehicles. High heterogeneity between studies and the inability to exclude other sources of infection means that the risk of influenza transmission from an index case to other passengers cannot be accurately quantified. A paucity of evidence was identified describing severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus transmission events associated with transportation systems or hubs.

CONCLUSION

Air transportation appears important in accelerating and amplifying influenza propagation. Transmission occurs aboard aeroplanes, at the destination and possibly at airports. Control measures to prevent influenza transmission on cruise ships are needed to reduce morbidity and mortality. There is no recent evidence of sea transport accelerating influenza or coronavirus spread to new areas. Further investigation is required regarding the roles of ground transportation systems and transport hubs in pandemic situations.

Risk Factors for influenza A(H1N1)pdm09 among students, Beijing, China

To identify risk factors associated with influenza A(H1N1)pdm09 among students in Beijing, China, we conducted a case-control study. Participants (304 case-patients and 608 controls, age range 6-19 years) were interviewed by using a standardized questionnaire. We found that in addition to vaccination, nonpharmaceutical interventions appeared to be protective.

Policy resistance undermines superspreader vaccination strategies for influenza

Theoretical models of infection spread on networks predict that targeting vaccination at individuals with a very large number of contacts (superspreaders) can reduce infection incidence by a significant margin. These models generally assume that superspreaders will always agree to be vaccinated. Hence, they cannot capture unintended consequences such as policy resistance, where the behavioral response induced by a new vaccine policy tends to reduce the expected benefits of the policy. Here, we couple a model of influenza transmission on an empirically-based contact network with a psychologically structured model of influenza vaccinating behavior, where individual vaccinating decisions depend on social learning and past experiences of perceived infections, vaccine complications and vaccine failures. We find that policy resistance almost completely undermines the effectiveness of superspreader strategies: the most commonly explored approaches that target a randomly chosen neighbor of an individual, or that preferentially choose neighbors with many contacts, provide at best a 2% relative improvement over their non-targeted counterpart as compared to 12% when behavioral feedbacks are ignored. Increased vaccine coverage in super spreaders is offset by decreased coverage in non-superspreaders, and superspreaders also have a higher rate of perceived vaccine failures on account of being infected more often. Including incentives for vaccination provides modest improvements in outcomes. We conclude that the design of influenza vaccine strategies involving widespread incentive use and/or targeting of superspreaders should account for policy resistance, and mitigate it whenever possible.

Heterogeneity in viral shedding among individuals with medically attended influenza A virus infection

Compared with the average transmissibility of human influenza A virus, much less attention has been paid to the potential variability in its transmissibility. We considered viral shedding as a proxy for infectiousness and explored the heterogeneity of infectiousness among patients with medically attended seasonal influenza A virus infection. The analysis revealed that viral shedding is more heterogeneous in children than in adults. The top 20% most infectious children and adults were estimated to be responsible for 89%-96% and 78%-82%, respectively, of the total infectiousness in each age group. Further investigation is required to correlate the substantial variations in viral shedding with heterogeneity in actual transmissibility.

Protection by face masks against influenza A(H1N1)pdm09 virus on trans-Pacific passenger aircraft, 2009

In response to several influenza A(H1N1)pdm09 infections that developed in passengers after they traveled on the same 2 flights from New York, New York, USA, to Hong Kong, China, to Fuzhou, China, we assessed transmission of influenza A(H1N1)pdm09 virus on these flights. We defined a case of infection as onset of fever and respiratory symptoms and detection of virus by PCR in a passenger or crew member of either flight. Illness developed only in passengers who traveled on the New York to Hong Kong flight. We compared exposures of 9 case-passengers with those of 32 asymptomatic control-passengers. None of the 9 case-passengers, compared with 47% (15/32) of control-passengers, wore a face mask for the entire flight (odds ratio 0, 95% CI 0-0.71). The source case-passenger was not identified. Wearing a face mask was a protective factor against influenza infection. We recommend a more comprehensive intervention study to accurately estimate this effect.

Attack rates assessment of the 2009 pandemic H1N1 influenza A in children and their contacts: a systematic review and meta-analysis

BACKGROUND

The recent H1N1 influenza A pandemic was marked by multiple reports of illness and hospitalization in children, suggesting that children may have played a major role in the propagation of the virus. A comprehensive detailed analysis of the attack rates among children as compared with their contacts in various settings is of great importance for understanding their unique role in influenza pandemics.

METHODOLOGY/PRINCIPAL FINDINGS

We searched MEDLINE (PubMed) and Embase for published studies reporting outbreak investigations with direct measurements of attack rates of the 2009 pandemic H1N1 influenza A among children, and quantified how these compare with those of their contacts. We identified 50 articles suitable for review, which reported school, household, travel and social events. The selected reports and our meta-analysis indicated that children had significantly higher attack rates as compared to adults, and that this phenomenon was observed for both virologically confirmed and clinical cases, in various settings and locations around the world. The review also provided insight into some characteristics of transmission between children and their contacts in the various settings.

CONCLUSION/SIGNIFICANCE

The consistently higher attack rates of the 2009 pandemic H1N1 influenza A among children, as compared to adults, as well as the magnitude of the difference is important for understanding the contribution of children to disease burden, for implementation of mitigation strategies directed towards children, as well as more precise mathematical modeling and simulation of future influenza pandemics.