Efficacies of the original and modified World Health Organization-recommended hand-rub formulations

Development and Characterization of a Hand Rub Gel Produced with Artisan Alcohol (Puntas), Silver Nanoparticles, and Saponins from Quinoa

The emergence of the global pandemic (COVID-19) has directed global attention towards the importance of hygiene as the primary defense against various infections. In this sense, one of the frequent recommendations of the World Health Organization (WHO) is regular hand washing and the use of alcohol-based hand sanitizers. Ethanol is the most widely used alcohol due to its effectiveness in eliminating pathogens, ease of use, and widespread production. However, artisanal alcohol, generally used as a spirit drink, could be a viable alternative for developing sanitizing gels. In this study, the use of alcohol "Puntas", silver nanoparticles, and saponins from quinoa was evaluated to produce hand sanitizer gels. The rheological, physicochemical, and antimicrobial properties were evaluated. In the previous assays, the formulations were adjusted to be similar in visual viscosity to the control gel. A clear decrease in the apparent viscosity was observed with increasing shear rate, and an inversely proportional relationship was observed with the amount of ethyl alcohol used in the formulations. The flow behavior index (n) values reflected a pseudoplastic behavior. Oscillatory dynamic tests were performed to analyze the viscoelastic behavior of gels. A decrease in storage modulus (G') and an increase in loss modulus (G″) as a function of the angular velocity (ω) was observed. The evaluation of pH showed that the gels complied with the requirements to be in contact with the skin of the people, and the textural parameters showed that the control gel was the hardest. The use of artisan alcohol could be an excellent alternative to produce sanitizer gel and contribute to the requirements of the population.

Was the Reduction in Seasonal Influenza Transmission during 2020 Attributable to Non-Pharmaceutical Interventions to Contain Coronavirus Disease 2019 (COVID-19) in Japan?

We quantified the effects of adherence to various non-pharmaceutical interventions (NPIs) on the seasonal influenza epidemic dynamics in Japan during 2020. The total monthly number of seasonal influenza cases per sentinel site (seasonal influenza activity) reported to the National Epidemiological Surveillance of Infectious Diseases and alternative NPI indicators (retail sales of hand hygiene products and number of airline passenger arrivals) from 2014−2020 were collected. The average number of monthly seasonal influenza cases in 2020 had decreased by approximately 66.0% (p < 0.001) compared to those in the preceding six years. An increase in retail sales of hand hygiene products of ¥1 billion over a 3-month period led to a 15.5% (95% confidence interval [CI]: 10.9−20.0%; p < 0.001) reduction in seasonal influenza activity. An increase in the average of one million domestic and international airline passenger arrivals had a significant association with seasonal influenza activity by 11.6% at lag 0−2 months (95% CI: 6.70−16.5%; p < 0.001) and 30.9% at lag 0−2 months (95% CI: 20.9−40.9%; p < 0.001). NPI adherence was associated with decreased seasonal influenza activity during the COVID-19 pandemic in Japan, which has crucial implications for planning public health interventions to minimize the health consequences of adverse seasonal influenza epidemics.

The application of normative documents for determination of biocidal activity of disinfectants and antiseptics dedicated for medical area: a narrative review

Disinfectants and antiseptics are important weapons to reduce the number of microorganisms and thus to limit the number of infections. Different methods of antimicrobial activity testing, often not standardised, without appropriate controls and not validated are applied. To address these issues, several European Standards (EN) have been developed, describing the test methods to determine whether chemical disinfectants or antiseptic products have appropriate bactericidal, sporicidal, mycobactericidal or tuberculocidal activity; fungicidal or yeasticidal activity; or virucidal activity. In this narrative review, the 17 EN concerning evaluation of the above-mentioned antimicrobial activity of preparations dedicated to the medical area are briefly reviewed, together with recent publications on this topic. Suspension and carrier tests have been performed in clean and dirty conditions simulating the medical area. In addition, a wide range of applications of these standards has been presented in the research of biocides for hand antisepsis, surfaces disinfection, including airborne disinfection as well as medical device and medical textile disinfection. The role of normative documents in the investigation of antimicrobial activity of disinfectants and antiseptics to limit infections has been underestimated. This narrative review aims to persuade researchers to conduct antimicrobial activity testing in line with validated EN and highlights an existing gap in ongoing research. It also aims to raise awareness of the wide range of biocidal activity tests with standardised methods in medical area. We also pay attention to the recently developed European Pharmacopoeia monography concerning the testing of bactericidal and fungicidal activity of antiseptics classified as medicinal products.

Inactivation of SARS-CoV-2 by 2 commercially available Benzalkonium chloride-based hand sanitizers in comparison with an 80% ethanol-based hand sanitizer

Background

The CDC and WHO recommend alcohol-based hand sanitizers to inactivate severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2].

Aim

Benzalkonium chloride [BAK] is another hand sanitizer active ingredient that could be used in response to the global pandemic. Deployment of BAK-based hand sanitizers could reduce shortages of alcohol products and increase hand hygiene options where there are social, physical, and toxicological constraints on alcohol use.

Methods

Two commercially available BAK-based hand sanitizers, a concentrate diluted on-site with water and a ready-to-use product, were tested for activity against SARS-CoV-2 in the European Norm Virucidal Activity Suspension Test [EN14476]. A WHO and CDC-recommended 80% alcohol-based hand sanitizer formulation was tested in parallel.

Findings

Both BAK formulations demonstrated a ≥4.0 log₁₀ reduction of SARS-CoV-2 in 30 seconds, meeting the EN14476 performance standard for virucidal activity against SARS-CoV-2 and matching the in vitro effectiveness of the ethanol-based sanitizer.

Conclusion

These findings indicate that a commercial BAK hand hygiene formulation may be another effective means of inactivating the SARS-CoV-2 virus and could be considered as option for pandemic response.

Disinfection methods against SARS-CoV-2: a systematic review

Background

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of coronavirus disease 2019, has caused millions of deaths worldwide. The virus is transmitted by inhalation of infectious particles suspended in the air, direct deposition on mucous membranes and indirect contact via contaminated surfaces. Disinfection methods that can halt such transmission are important in this pandemic and in future viral infections.

Aim

To highlight the efficacy of several disinfection methods against SARS-CoV-2 based on up-to-date evidence found in the literature.

Methods

Two databases were searched to identify studies that assessed disinfection methods used against SARS-CoV-2. In total, 1229 studies were identified and 60 of these were included in this review. Quality assessment was evaluated by the Office of Health Assessment and Translation's risk-of-bias tool.

Findings

Twenty-eight studies investigated disinfection methods on environmental surfaces, 16 studies investigated disinfection methods on biological surfaces, four studies investigated disinfection methods for airborne coronavirus, and 16 studies investigated methods used to recondition personal protective equipment (PPE).

Conclusions

Several household and hospital disinfection agents and ultraviolet-C (UV-C) irradiation were effective for inactivation of SARS-CoV-2 on environmental surfaces. Formulations containing povidone-iodine can provide virucidal action on the skin and mucous membranes. In the case of hand hygiene, typical soap bars and alcohols can inactivate SARS-CoV-2. Air filtration systems incorporated with materials that possess catalytic properties, UV-C devices and heating systems can reduce airborne viral particles effectively. The decontamination of PPE can be conducted safely by heat and ozone treatment.

In Vitro Evaluation of the Virucidal Activity of Different Povidone-Iodine Formulations Against Murine and Human Coronaviruses

Introduction

Polyvinylpyrrolidone–iodine (PVP-I) demonstrates broad-spectrum anti-infective activity and is available in different formulations for oral rinse and topical use in medical and personal care settings. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has underscored the need to supplement available preventive strategies.

Methods

We assessed virucidal activity of PVP-I formulations, including 0.5% (w/v) solution, 5.0% (w/v) solution, 7.5% (w/v) scrub, and 10.0% (w/v) solution, versus placebos when challenged with coronaviruses in two in vitro studies. Murine coronavirus strain A59 (American Type Culture Collection [ATCC]^® VR-764™), human coronavirus strain OC43 (ZeptoMetrix Corp. #0810024CF), human coronavirus strain NL63 (ZeptoMetrix Corp. #0810228CF), and human coronavirus strain 229E (ATCC^® VR-740™) were used as surrogates for SARS-CoV-2. Both studies used the American Society for Testing and Materials in vitro time-kill method.

Results

All active PVP-I formulations in study 1 demonstrated virucidal activity at 15 s, with mean log₁₀ reduction of greater than 4.56 or greater than 99.99% inactivation; a cytotoxic effect against the National Collection of Type Cultures clone 1469 host cells was observed with 5.0% (w/v) solution, 7.5% (w/v) scrub, and 10.0% (w/v) solution. Active PVP-I formulations in study 2 demonstrated effective virucidal activity against coronaviruses in less than 15 s; log₁₀ reduction in viral titer for each coronavirus strain was consistently higher for 10.0% (w/v) solution and 0.5% (w/v) solution versus 7.5% (w/v) scrub.

Conclusion

Both studies demonstrated in vitro virucidal activity of PVP-I formulations when challenged with SARS-CoV-2 surrogate coronaviruses. Although promising, further investigations are needed to evaluate SARS-CoV-2 inactivation.

Ethanol Susceptibility of SARS-CoV-2 and Other Enveloped Viruses

Ethanol is an effective disinfectant against the novel coronavirus SARS-CoV-2. However, its effective concentration has not been shown, and we therefore analyzed the effects of different concentrations of ethanol on SARS-CoV-2. When SARS-CoV-2 was treated with varying ethanol concentrations and examined for changes in infectivity, the ethanol concentration at which 99% of the infectious titers were reduced was 24.1% (w/w) [29.3% (v/v)]. For reference, ethanol susceptibility was also examined with other envelope viruses, including influenza virus, vesicular stomatitis virus in the family Rhabdoviridae, and Newcastle disease virus in the family Paramyxoviridae, and the 99% inhibitory concentrations were found to be 28.8%(w/w) [34.8% (v/v)], 24.0% (w/w) [29.2% (v/v)], and 13.3% (w/w) [16.4% (v/v)], respectively. Some differences from SARS-CoV-2 were observed, but the differences were not significant. It was concluded that ethanol at a concentration of 30%(w/w) [36.2% (v/v)] almost completely inactivates SARS-CoV-2.

Transmissibility and transmission of respiratory viruses

Human respiratory virus infections lead to a spectrum of respiratory symptoms and disease severity, contributing to substantial morbidity, mortality and economic losses worldwide, as seen in the COVID-19 pandemic. Belonging to diverse families, respiratory viruses differ in how easy they spread (transmissibility) and the mechanism (modes) of transmission. Transmissibility as estimated by the basic reproduction number (R₀) or secondary attack rate is heterogeneous for the same virus. Respiratory viruses can be transmitted via four major modes of transmission: direct (physical) contact, indirect contact (fomite), (large) droplets and (fine) aerosols. We know little about the relative contribution of each mode to the transmission of a particular virus in different settings, and how its variation affects transmissibility and transmission dynamics. Discussion on the particle size threshold between droplets and aerosols and the importance of aerosol transmission for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus is ongoing. Mechanistic evidence supports the efficacies of non-pharmaceutical interventions with regard to virus reduction; however, more data are needed on their effectiveness in reducing transmission. Understanding the relative contribution of different modes to transmission is crucial to inform the effectiveness of non-pharmaceutical interventions in the population. Intervening against multiple modes of transmission should be more effective than acting on a single mode.