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Chow VTK, Tay DJW, Chen MIC, Tang JW, Milton DK, Tham KW. Influenza A and B Viruses in Fine Aerosols of Exhaled Breath Samples from Patients in Tropical Singapore. Viruses 2023; 15:2033. [PMID: 37896810 PMCID: PMC10612062 DOI: 10.3390/v15102033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
Influenza is a highly contagious respiratory illness that commonly causes outbreaks among human communities. Details about the exact nature of the droplets produced by human respiratory activities such as breathing, and their potential to carry and transmit influenza A and B viruses is still not fully understood. The objective of our study was to characterize and quantify influenza viral shedding in exhaled aerosols from natural patient breath, and to determine their viral infectivity among participants in a university cohort in tropical Singapore. Using the Gesundheit-II exhaled breath sampling apparatus, samples of exhaled breath of two aerosol size fractions ("coarse" > 5 µm and "fine" ≤ 5 µm) were collected and analyzed from 31 study participants, i.e., 24 with influenza A (including H1N1 and H3N2 subtypes) and 7 with influenza B (including Victoria and Yamagata lineages). Influenza viral copy number was quantified using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Infectivity of influenza virus in the fine particle fraction was determined by culturing in Madin-Darby canine kidney cells. Exhaled influenza virus RNA generation rates ranged from 9 to 1.67 × 105 and 10 to 1.24 × 104 influenza virus RNA copies per minute for the fine and coarse aerosol fractions, respectively. Compared to the coarse aerosol fractions, influenza A and B viruses were detected more frequently in the fine aerosol fractions that harbored 12-fold higher viral loads. Culturable virus was recovered from the fine aerosol fractions from 9 of the 31 subjects (29%). These findings constitute additional evidence to reiterate the important role of fine aerosols in influenza transmission and provide a baseline range of influenza virus RNA generation rates.
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Affiliation(s)
- Vincent T. K. Chow
- Infectious Diseases Translational Research Program, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545, Singapore;
| | - Douglas Jie Wen Tay
- Infectious Diseases Translational Research Program, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545, Singapore;
| | - Mark I. C. Chen
- Research Office, National Centre for Infectious Diseases, Singapore 308442, Singapore;
| | - Julian W. Tang
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK;
| | - Donald K. Milton
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD 20742, USA;
| | - Kwok Wai Tham
- Department of the Built Environment, College of Design and Engineering, National University of Singapore, Singapore 117356, Singapore
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Abstract
Peripheral blood oxygen saturation (SpO 2) is an essential indicator of respiratory functionality and received increasing attention during the COVID-19 pandemic. Clinical findings show that COVID-19 patients can have significantly low SpO 2 before any obvious symptoms. Measuring an individual's SpO 2 without having to come into contact with the person can lower the risk of cross contamination and blood circulation problems. The prevalence of smartphones has motivated researchers to investigate methods for monitoring SpO 2 using smartphone cameras. Most prior schemes involving smartphones are contact-based: They require using a fingertip to cover the phone's camera and the nearby light source to capture reemitted light from the illuminated tissue. In this paper, we propose the first convolutional neural network based noncontact SpO 2 estimation scheme using smartphone cameras. The scheme analyzes the videos of an individual's hand for physiological sensing, which is convenient and comfortable for users and can protect their privacy and allow for keeping face masks on. We design explainable neural network architectures inspired by the optophysiological models for SpO 2 measurement and demonstrate the explainability by visualizing the weights for channel combination. Our proposed models outperform the state-of-the-art model that is designed for contact-based SpO 2 measurement, showing the potential of the proposed method to contribute to public health. We also analyze the impact of skin type and the side of a hand on SpO 2 estimation performance.
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Tan KS, Ong SWX, Koh MH, Tay DJW, Aw DZH, Nah YW, Abdullah MRB, Coleman KK, Milton DK, Chu JJH, Chow VTK, Tambyah PA, Tham KW. SARS-CoV-2 Omicron variant shedding during respiratory activities. Int J Infect Dis 2023; 131:19-25. [PMID: 36948451 PMCID: PMC10028358 DOI: 10.1016/j.ijid.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/24/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND As the world transitions to COVID-19 endemicity, studies focusing on aerosol shedding of highly transmissible SARS-CoV-2 variants of concern (VOCs) are vital for the calibration of infection control measures against VOCs that are likely to circulate seasonally. OBJECTIVE This follow-up G-II aerosol sampling study aims to compare the aerosol shedding patterns of Omicron VOC samples with pre-Omicron variants analyzed in our previous study. STUDY DESIGN Coarse and fine aerosol samples from 47 SARS-CoV-2 infected patients were collected during various respiratory activities (passive breathing, talking, and singing) and analyzed via reverse transcription quantitative polymerase chain reaction (RT-qPCR) and virus culture. RESULTS Compared to patients infected with pre-Omicron variants, comparable SARS-CoV-2 RNA copy numbers were detectable in aerosol samples of Omicron infected patients despite being fully vaccinated. Omicron-infected patients also showed a slight increase in viral aerosol shedding during breathing activities, and were more likely to have persistent aerosol shedding beyond 7 days post-disease onset. CONCLUSION This follow-up study reaffirms the aerosol shedding properties of Omicron, and should guide continued layering of public health interventions even in highly vaccinated populations.
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Affiliation(s)
- Kai Sen Tan
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Biosafety Level 3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Sean Wei Xiang Ong
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Ming Hui Koh
- Department of the Built Environment, College of Design and Engineering, National University of Singapore, Singapore
| | - Douglas Jie Wen Tay
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Biosafety Level 3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Daryl Zheng Hao Aw
- Department of the Built Environment, College of Design and Engineering, National University of Singapore, Singapore
| | - Yi Wei Nah
- Department of the Built Environment, College of Design and Engineering, National University of Singapore, Singapore
| | | | - Kristen K Coleman
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD
| | - Donald K Milton
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD
| | - Justin Jang Hann Chu
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Biosafety Level 3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Vincent T K Chow
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Paul Anantharajah Tambyah
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Kwok Wai Tham
- Department of the Built Environment, College of Design and Engineering, National University of Singapore, Singapore.
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Lai J, Coleman KK, Tai SHS, German J, Hong F, Albert B, Esparza Y, Srikakulapu AK, Schanz M, Maldonado IS, Oertel M, Fadul N, Gold TL, Weston S, Mullins K, McPhaul KM, Frieman M, Milton DK. Exhaled Breath Aerosol Shedding of Highly Transmissible Versus Prior Severe Acute Respiratory Syndrome Coronavirus 2 Variants. Clin Infect Dis 2023; 76:786-794. [PMID: 36285523 PMCID: PMC9620356 DOI: 10.1093/cid/ciac846] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Aerosol inhalation is recognized as the dominant mode of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Three highly transmissible lineages evolved during the pandemic. One hypothesis to explain increased transmissibility is that natural selection favors variants with higher rates of viral aerosol shedding. However, the extent of aerosol shedding of successive SARS-CoV-2 variants is unknown. We aimed to measure the infectivity and rate of SARS-CoV-2 shedding into exhaled breath aerosol (EBA) by individuals during the Delta and Omicron waves and compared those rates with those of prior SARS-CoV-2 variants from our previously published work. METHODS Individuals with coronavirus disease 2019 (COVID-19) (n = 93; 32 vaccinated and 20 boosted) were recruited to give samples, including 30-minute breath samples into a Gesundheit-II EBA sampler. Samples were quantified for viral RNA using reverse-transcription polymerase chain reaction and cultured for virus. RESULTS Alpha (n = 4), Delta (n = 3), and Omicron (n = 29) cases shed significantly more viral RNA copies into EBAs than cases infected with ancestral strains and variants not associated with increased transmissibility (n = 57). All Delta and Omicron cases were fully vaccinated and most Omicron cases were boosted. We cultured virus from the EBA of 1 boosted and 3 fully vaccinated cases. CONCLUSIONS Alpha, Delta, and Omicron independently evolved high viral aerosol shedding phenotypes, demonstrating convergent evolution. Vaccinated and boosted cases can shed infectious SARS-CoV-2 via EBA. These findings support a dominant role of infectious aerosols in transmission of SARS-CoV-2. Monitoring aerosol shedding from new variants and emerging pathogens can be an important component of future threat assessments and guide interventions to prevent transmission.
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Affiliation(s)
- Jianyu Lai
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Kristen K Coleman
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - S H Sheldon Tai
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Jennifer German
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Filbert Hong
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Barbara Albert
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Yi Esparza
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Aditya K Srikakulapu
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Maria Schanz
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Isabel Sierra Maldonado
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Molly Oertel
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Naja Fadul
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - T Louie Gold
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Stuart Weston
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kristin Mullins
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathleen M McPhaul
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Matthew Frieman
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Donald K Milton
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
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Morawska L, Bahnfleth W, Bluyssen PM, Boerstra A, Buonanno G, Dancer SJ, Floto A, Franchimon F, Haworth C, Hogeling J, Isaxon C, Jimenez JL, Kurnitski J, Li Y, Loomans M, Marks G, Marr LC, Mazzarella L, Melikov AK, Miller S, Milton DK, Nazaroff W, Nielsen PV, Noakes C, Peccia J, Querol X, Sekhar C, Seppänen O, Tanabe SI, Tellier R, Tham KW, Wargocki P, Wierzbicka A. COVID-19 and Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better? Clin Infect Dis 2023; 76:1854-1859. [PMID: 36763042 DOI: 10.1093/cid/ciad068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/22/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
This is an account that should be heard of an important struggle: the struggle of a large group of experts who came together at the beginning of the Covid-19 pandemic to warn the world about the risk of airborne transmission and the consequences of ignoring it. We alerted the World Health Organization (WHO) about the potential significance of the airborne transmission of SARS-CoV-2 and the urgent need to control it, but our concerns were dismissed. Here we describe how this happened and the consequences. We hope that by reporting this story, we can raise awareness of the importance of interdisciplinary collaboration and the need to be open to new evidence, and to prevent it from happening again. Acknowledgement of an issue and the emergence of new evidence related to it, is the first necessary step towards finding effective mitigation solutions.
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Affiliation(s)
- Lidia Morawska
- International Laboratory for Air Quality and Heath, Queensland University of Technology, Brisbane, Australia
| | - William Bahnfleth
- Department of Architectural Engineering, The Pennsylvania State University, USA
| | - Philomena M Bluyssen
- Faculty of Architecture and the Built Environment, Delft University of Technology, The Netherlands
| | - Atze Boerstra
- REHVA (Federation of European Heating, Ventilation and Air Conditioning Associations), BBA Binnenmilieu, The Netherlands
| | - Giorgio Buonanno
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, Italy
| | | | - Andres Floto
- Department of Medicine, University of Cambridge, United Kingdom
| | | | - Charles Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and Department of Medicine, University of Cambridge, United Kingdom
| | - Jaap Hogeling
- International Standards at ISSO, ISSO International Project, The Netherlands
| | | | - Jose L Jimenez
- Department of Chemistry, and Cooperative Institute for Research in Environmental Sciences (CIRES), University of Colorado, Boulder, USA
| | - Jarek Kurnitski
- REHVA Technology and Research Committee, Tallinn University of Technology, Estonia
| | - Yuguo Li
- Department of Mechanical Engineering, Hong Kong University, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Marcel Loomans
- Department of the Built Environment, Eindhoven University of Technology (TU/e), The Netherlands
| | - Guy Marks
- Centre for Air quality Research and evaluation (CAR), University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Linsey C Marr
- Civil and Environmental Engineering, Virginia Tech, USA
| | | | - Arsen Krikor Melikov
- DTU Sustain, Department of Environmental and Resource Engineering, Technical University of Denmark
| | - Shelly Miller
- Mechanical Engineering, University of Colorado, Boulder, USA
| | - Donald K Milton
- Environmental Health, School of Public Health, University of Maryland, USA
| | - William Nazaroff
- Department of Civil and Environmental Engineering, University of California, Berkeley, California, USA
| | - Peter V Nielsen
- Faculty of Engineering and Science, Department of Civil Engineering, Aalborg University, Denmark
| | - Catherine Noakes
- School of Civil Engineering, University of Leeds, United Kingdom
| | | | - Xavier Querol
- Institute of Environmental Assessment and Water Research, Department of Geosciences, Spanish National Research Council, Barcelona, Spain
| | - Chandra Sekhar
- Department of the Built Environment, National University of Singapore, Singapore
| | | | | | | | - Kwok Wai Tham
- Department of the Built Environment, National University of Singapore, Singapore
| | - Pawel Wargocki
- DTU Sustain, Department of Environmental and Resource Engineering, Technical University of Denmark
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Qian J, Dong Q, Chun K, Zhu D, Zhang X, Mao Y, Culver JN, Tai S, German JR, Dean DP, Miller JT, Wang L, Wu T, Li T, Brozena AH, Briber RM, Milton DK, Bentley WE, Hu L. Highly stable, antiviral, antibacterial cotton textiles via molecular engineering. Nat Nanotechnol 2023; 18:168-176. [PMID: 36585515 DOI: 10.1038/s41565-022-01278-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/27/2022] [Indexed: 05/25/2023]
Abstract
Cotton textiles are ubiquitous in daily life and are also one of the primary mediums for transmitting viruses and bacteria. Conventional approaches to fabricating antiviral and antibacterial textiles generally load functional additives onto the surface of the fabric and/or their microfibres. However, such modifications are susceptible to deterioration after long-term use due to leaching of the additives. Here we show a different method to impregnate copper ions into the cellulose matrix to form a copper ion-textile (Cu-IT), in which the copper ions strongly coordinate with the oxygen-containing polar functional groups (for example, hydroxyl) of the cellulose chains. The Cu-IT displays high antiviral and antibacterial performance against tobacco mosaic virus and influenza A virus, and Escherichia coli, Salmonella typhimurium, Pseudomonas aeruginosa and Bacillus subtilis bacteria due to the antimicrobial properties of copper. Furthermore, the strong coordination bonding of copper ions with the hydroxyl functionalities endows the Cu-IT with excellent air/water retainability and superior mechanical stability, which can meet daily use and resist repeated washing. This method to fabricate Cu-IT is cost-effective, ecofriendly and highly scalable, and this textile appears very promising for use in household products, public facilities and medical settings.
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Affiliation(s)
- Ji Qian
- Department of Materials Science and Engineering, University of Maryland, College Park, MD, USA
| | - Qi Dong
- Department of Materials Science and Engineering, University of Maryland, College Park, MD, USA
| | - Kayla Chun
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
- Institute for Bioscience and Biotechnology Research, University of Maryland, College Park, MD, USA
- Robert E. Fischell Institute for Biomedical Devices, University of Maryland, College Park, MD, USA
| | - Dongyang Zhu
- Department of Materials Science and Engineering, University of Maryland, College Park, MD, USA
| | - Xin Zhang
- Department of Materials Science and Engineering, University of Maryland, College Park, MD, USA
| | - Yimin Mao
- Department of Materials Science and Engineering, University of Maryland, College Park, MD, USA
- NIST Center for Neutron Research, National Institute of Standards and Technology (NIST), Gaithersburg, MD, USA
| | - James N Culver
- Institute for Bioscience and Biotechnology Research, University of Maryland, College Park, MD, USA
- Department of Plant Science and Landscape Architecture, University of Maryland, College Park, MD, USA
| | - Sheldon Tai
- Maryland Institute for Applied Environmental Health, University of Maryland, College Park, MD, USA
| | - Jennifer R German
- Maryland Institute for Applied Environmental Health, University of Maryland, College Park, MD, USA
| | - David P Dean
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN, USA
| | - Jeffrey T Miller
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN, USA
| | - Liguang Wang
- X-ray Science Division, Argonne National Laboratory, Lemont, IL, USA
| | - Tianpin Wu
- X-ray Science Division, Argonne National Laboratory, Lemont, IL, USA
| | - Tian Li
- Department of Materials Science and Engineering, University of Maryland, College Park, MD, USA
| | - Alexandra H Brozena
- Department of Materials Science and Engineering, University of Maryland, College Park, MD, USA
| | - Robert M Briber
- Department of Materials Science and Engineering, University of Maryland, College Park, MD, USA
| | - Donald K Milton
- Department of Plant Science and Landscape Architecture, University of Maryland, College Park, MD, USA
| | - William E Bentley
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA.
- Institute for Bioscience and Biotechnology Research, University of Maryland, College Park, MD, USA.
- Robert E. Fischell Institute for Biomedical Devices, University of Maryland, College Park, MD, USA.
| | - Liangbing Hu
- Department of Materials Science and Engineering, University of Maryland, College Park, MD, USA.
- Center for Materials Innovation, University of Maryland, College Park, MD, USA.
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Adenaiye OO, Lai J, Bueno de Mesquita PJ, Hong F, Youssefi S, German J, Tai SHS, Albert B, Schanz M, Weston S, Hang J, Fung C, Chung HK, Coleman KK, Sapoval N, Treangen T, Berry IM, Mullins K, Frieman M, Ma T, Milton DK. Infectious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Exhaled Aerosols and Efficacy of Masks During Early Mild Infection. Clin Infect Dis 2022; 75:e241-e248. [PMID: 34519774 PMCID: PMC8522431 DOI: 10.1093/cid/ciab797] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemiology implicates airborne transmission; aerosol infectiousness and impacts of masks and variants on aerosol shedding are not well understood. METHODS We recruited coronavirus disease 2019 (COVID-19) cases to give blood, saliva, mid-turbinate and fomite (phone) swabs, and 30-minute breath samples while vocalizing into a Gesundheit-II, with and without masks at up to 2 visits 2 days apart. We quantified and sequenced viral RNA, cultured virus, and assayed serum samples for anti-spike and anti-receptor binding domain antibodies. RESULTS We enrolled 49 seronegative cases (mean days post onset 3.8 ± 2.1), May 2020 through April 2021. We detected SARS-CoV-2 RNA in 36% of fine (≤5 µm), 26% of coarse (>5 µm) aerosols, and 52% of fomite samples overall and in all samples from 4 alpha variant cases. Masks reduced viral RNA by 48% (95% confidence interval [CI], 3 to 72%) in fine and by 77% (95% CI, 51 to 89%) in coarse aerosols; cloth and surgical masks were not significantly different. The alpha variant was associated with a 43-fold (95% CI, 6.6- to 280-fold) increase in fine aerosol viral RNA, compared with earlier viruses, that remained a significant 18-fold (95% CI, 3.4- to 92-fold) increase adjusting for viral RNA in saliva, swabs, and other potential confounders. Two fine aerosol samples, collected while participants wore masks, were culture-positive. CONCLUSIONS SARS-CoV-2 is evolving toward more efficient aerosol generation and loose-fitting masks provide significant but only modest source control. Therefore, until vaccination rates are very high, continued layered controls and tight-fitting masks and respirators will be necessary.
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Affiliation(s)
- Oluwasanmi O Adenaiye
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Jianyu Lai
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - P Jacob Bueno de Mesquita
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Filbert Hong
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Somayeh Youssefi
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Jennifer German
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - S H Sheldon Tai
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Barbara Albert
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Maria Schanz
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Stuart Weston
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jun Hang
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Christian Fung
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Hye Kyung Chung
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Kristen K Coleman
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Nicolae Sapoval
- Department of Computer Science, Rice University, Houston, Texas, USA
| | - Todd Treangen
- Department of Computer Science, Rice University, Houston, Texas, USA
| | - Irina Maljkovic Berry
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Kristin Mullins
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matthew Frieman
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tianzhou Ma
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Donald K Milton
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
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Wang L, Lin T, Da Costa H, Zhu S, Stockman T, Kumar A, Weaver J, Spede M, Milton DK, Hertzberg J, Toohey DW, Vance ME, Miller SL, Srebric J. Characterization of aerosol plumes from singing and playing wind instruments associated with the risk of airborne virus transmission. Indoor Air 2022; 32:e13064. [PMID: 35762243 PMCID: PMC9328346 DOI: 10.1111/ina.13064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/25/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
The exhalation of aerosols during musical performances or rehearsals posed a risk of airborne virus transmission in the COVID-19 pandemic. Previous research studied aerosol plumes by only focusing on one risk factor, either the source strength or convective transport capability. Furthermore, the source strength was characterized by the aerosol concentration and ignored the airflow rate needed for risk analysis in actual musical performances. This study characterizes aerosol plumes that account for both the source strength and convective transport capability by conducting experiments with 18 human subjects. The source strength was characterized by the source aerosol emission rate, defined as the source aerosol concentration multiplied by the source airflow rate (brass 383 particle/s, singing 408 particle/s, and woodwind 480 particle/s). The convective transport capability was characterized by the plume influence distance, defined as the sum of the horizontal jet length and horizontal instrument length (brass 0.6 m, singing 0.6 m and woodwind 0.8 m). Results indicate that woodwind instruments produced the highest risk with approximately 20% higher source aerosol emission rates and 30% higher plume influence distances compared with the average of the same risk indicators for singing and brass instruments. Interestingly, the clarinet performance produced moderate source aerosol concentrations at the instrument's bell, but had the highest source aerosol emission rates due to high source airflow rates. Flute performance generated plumes with the lowest source aerosol emission rates but the highest plume influence distances due to the highest source airflow rate. Notably, these comprehensive results show that the source airflow is a critical component of the risk of airborne disease transmission. The effectiveness of masking and bell covering in reducing aerosol transmission is due to the mitigation of both source aerosol concentrations and plume influence distances. This study also found a musician who generated approximately five times more source aerosol concentrations than those of the other musicians who played the same instrument. Despite voice and brass instruments producing measurably lower average risk, it is possible to have an individual musician produce aerosol plumes with high source strength, resulting in enhanced transmission risk; however, our sample size was too small to make generalizable conclusions regarding the broad musician population.
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Affiliation(s)
- Lingzhe Wang
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMarylandUSA
| | - Tong Lin
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMarylandUSA
| | - Hevander Da Costa
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMarylandUSA
| | - Shengwei Zhu
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMarylandUSA
| | - Tehya Stockman
- Department of Civil, Environmental, and Architectural EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Abhishek Kumar
- Department of Mechanical EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - James Weaver
- National Federation of State High School AssociationsIndianapolisIndianaUSA
| | - Mark Spede
- Department of Performing ArtsClemson UniversityClemsonSouth CarolinaUSA
| | - Donald K. Milton
- Maryland Institute for Applied Environmental Health, School of Public HealthUniversity of MarylandCollege ParkMarylandUSA
| | - Jean Hertzberg
- Department of Mechanical EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Darin W. Toohey
- Department of Atmospheric and Oceanic SciencesUniversity of Colorado BoulderBoulderColoradoUSA
| | - Marina E. Vance
- Department of Mechanical EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Shelly L. Miller
- Department of Mechanical EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Jelena Srebric
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMarylandUSA
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9
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Coleman KK, Tay DJW, Tan KS, Ong SWX, Than TS, Koh MH, Chin YQ, Nasir H, Mak TM, Chu JJH, Milton DK, Chow VTK, Tambyah PA, Chen M, Tham KW. Viral Load of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Respiratory Aerosols Emitted by Patients With Coronavirus Disease 2019 (COVID-19) While Breathing, Talking, and Singing. Clin Infect Dis 2022; 74:1722-1728. [PMID: 34358292 DOI: 10.1101/2021.07.15.21260561] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) superspreading events suggest that aerosols play an important role in driving the coronavirus disease 2019 (COVID-19) pandemic. To better understand how airborne SARS-CoV-2 transmission occurs, we sought to determine viral loads within coarse (>5 μm) and fine (≤5 μm) respiratory aerosols produced when breathing, talking, and singing. METHODS Using a G-II exhaled breath collector, we measured viral RNA in coarse and fine respiratory aerosols emitted by COVID-19 patients during 30 minutes of breathing, 15 minutes of talking, and 15 minutes of singing. RESULTS Thirteen participants (59%) emitted detectable levels of SARS-CoV-2 RNA in respiratory aerosols, including 3 asymptomatic and 1 presymptomatic patient. Viral loads ranged from 63-5821 N gene copies per expiratory activity per participant, with high person-to-person variation. Patients earlier in illness were more likely to emit detectable RNA. Two participants, sampled on day 3 of illness, accounted for 52% of total viral load. Overall, 94% of SARS-CoV-2 RNA copies were emitted by talking and singing. Interestingly, 7 participants emitted more virus from talking than singing. Overall, fine aerosols constituted 85% of the viral load detected in our study. Virus cultures were negative. CONCLUSIONS Fine aerosols produced by talking and singing contain more SARS-CoV-2 copies than coarse aerosols and may play a significant role in SARS-CoV-2 transmission. Exposure to fine aerosols, especially indoors, should be mitigated. Isolating viable SARS-CoV-2 from respiratory aerosol samples remains challenging; whether this can be more easily accomplished for emerging SARS-CoV-2 variants is an urgent enquiry necessitating larger-scale studies.
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Affiliation(s)
- Kristen K Coleman
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Douglas Jie Wen Tay
- Department of the Built Environment, National University of Singapore, Singapore
| | - Kai Sen Tan
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Biosafety Level 3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Sean Wei Xiang Ong
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - The Son Than
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
- Department of the Built Environment, National University of Singapore, Singapore
| | - Ming Hui Koh
- Department of the Built Environment, National University of Singapore, Singapore
| | - Yi Qing Chin
- National Centre for Infectious Diseases, Singapore
| | - Haziq Nasir
- Division of Infectious Diseases, Department of Medicine, National University Health System, National University of Singapore, Singapore
| | - Tze Minn Mak
- National Centre for Infectious Diseases, Singapore
| | - Justin Jang Hann Chu
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Biosafety Level 3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Vincent T K Chow
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Paul Anantharajah Tambyah
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Health System, National University of Singapore, Singapore
| | - Mark Chen
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kwok Wai Tham
- Department of the Built Environment, National University of Singapore, Singapore
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10
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Lai J, German J, Hong F, Tai SHS, McPhaul KM, Milton DK. Comparison of Saliva and Midturbinate Swabs for Detection of SARS-CoV-2. Microbiol Spectr 2022; 10:e0012822. [PMID: 35311575 PMCID: PMC9045394 DOI: 10.1128/spectrum.00128-22] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/17/2022] [Indexed: 01/25/2023] Open
Abstract
Saliva is an attractive sample for detecting SARS-CoV-2. However, contradictory reports exist concerning the sensitivity of saliva versus nasal swabs. We followed close contacts of COVID-19 cases for up to 14 days from the last exposure and collected self-reported symptoms, midturbinate swabs (MTS), and saliva every 2 or 3 days. Ct values, viral load, and frequency of viral detection by MTS and saliva were compared. Fifty-eight contacts provided 200 saliva-MTS pairs, and 14 contacts (13 with symptoms) had one or more positive samples. Saliva and MTS had similar rates of viral detection (P = 0.78) and substantial agreement (κ = 0.83). However, sensitivity varied significantly with time since symptom onset. Early on (days -3 to 2), saliva had 12 times (95% CI: 1.2, 130) greater likelihood of viral detection and 3.2 times (95% CI: 2.8, 3.8) higher RNA copy numbers compared to MTS. After day 2 of symptoms, there was a nonsignificant trend toward greater sensitivity using MTS. Saliva and MTS demonstrated high agreement making saliva a suitable alternative to MTS for SARS-CoV-2 detection. Saliva was more sensitive early in the infection when the transmission was most likely to occur, suggesting that it may be a superior and cost-effective screening tool for COVID-19. IMPORTANCE The findings of this manuscript are increasingly important with new variants that appear to have shorter incubation periods emerging, which may be more prone to detection in saliva before detection in nasal swabs. Therefore, there is an urgent need to provide the science to support the use of a detection method that is highly sensitive and widely acceptable to the public to improve screening rates and early detection. The manuscript presents the first evidence that saliva-based RT-PCR is more sensitive than MTS-based RT-PCR in detecting SARS-CoV-2 during the presymptomatic period - the critical period for unwitting onward transmission. Considering other advantages of saliva samples, including the lower cost, greater acceptability within the general population, and less risk to health care workers, our findings further supported the use of saliva to identify presymptomatic infection and prevent transmission of the virus.
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Affiliation(s)
- Jianyu Lai
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Jennifer German
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Filbert Hong
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - S.-H. Sheldon Tai
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Kathleen M. McPhaul
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Donald K. Milton
- Public Health Aerobiology and Biomarker Laboratory, Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
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11
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Kim S, Ryu H, Tai S, Pedowitz M, Rzasa JR, Pennachio DJ, Hajzus JR, Milton DK, Myers-Ward R, Daniels KM. Real-time ultra-sensitive detection of SARS-CoV-2 by quasi-freestanding epitaxial graphene-based biosensor. Biosens Bioelectron 2022; 197:113803. [PMID: 34814034 PMCID: PMC8595974 DOI: 10.1016/j.bios.2021.113803] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/06/2021] [Accepted: 11/13/2021] [Indexed: 12/30/2022]
Abstract
We report the rapid detection of SARS-CoV-2 in infected patients (mid-turbinate swabs and exhaled breath aerosol samples) in concentrations as low as 60 copies/mL of the virus in seconds by electrical transduction of the SARS-CoV-2 S1 spike protein antigen via SARS-CoV-2 S1 spike protein antibodies immobilized on bilayer quasi-freestanding epitaxial graphene without gate or signal amplification. The sensor demonstrates the spike protein antigen detection in a concentration as low as 1 ag/mL. The heterostructure of the SARS-CoV-2 antibody/graphene-based sensor is developed through a simple and low-cost fabrication technique. Furthermore, sensors integrated into a portable testing unit distinguished B.1.1.7 variant positive samples from infected patients (mid-turbinate swabs and saliva samples, 4000-8000 copies/mL) with a response time of as fast as 0.6 s. The sensor is reusable, allowing for reimmobilization of the crosslinker and antibodies on the biosensor after desorption of biomarkers by NaCl solution or heat treatment above 40 °C.
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Affiliation(s)
- Soaram Kim
- Department of Electrical and Computer Engineering, University of Maryland, College Park, MD, 20742, USA; Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, MD, 20742, USA.
| | - Heeju Ryu
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Sheldon Tai
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, 20742, USA
| | - Michael Pedowitz
- Department of Electrical and Computer Engineering, University of Maryland, College Park, MD, 20742, USA; Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, MD, 20742, USA
| | - John Robertson Rzasa
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, 20742, USA
| | | | | | - Donald K Milton
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, 20742, USA
| | | | - Kevin M Daniels
- Department of Electrical and Computer Engineering, University of Maryland, College Park, MD, 20742, USA; Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, MD, 20742, USA
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12
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Klompas M, Milton DK, Rhee C, Baker MA, Leekha S. Current Insights Into Respiratory Virus Transmission and Potential Implications for Infection Control Programs : A Narrative Review. Ann Intern Med 2021; 174:1710-1718. [PMID: 34748374 DOI: 10.7326/m21-2780] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Policies to prevent respiratory virus transmission in health care settings have traditionally divided organisms into Droplet versus Airborne categories. Droplet organisms (for example, influenza) are said to be transmitted via large respiratory secretions that rapidly fall to the ground within 1 to 2 meters and are adequately blocked by surgical masks. Airborne pathogens (for example, measles), by contrast, are transmitted by aerosols that are small enough and light enough to carry beyond 2 meters and to penetrate the gaps between masks and faces; health care workers are advised to wear N95 respirators and to place these patients in negative-pressure rooms. Respirators and negative-pressure rooms are also recommended when caring for patients with influenza or SARS-CoV-2 who are undergoing "aerosol-generating procedures," such as intubation. An increasing body of evidence, however, questions this framework. People routinely emit respiratory particles in a range of sizes, but most are aerosols, and most procedures do not generate meaningfully more aerosols than ordinary breathing, and far fewer than coughing, exercise, or labored breathing. Most transmission nonetheless occurs at close range because virus-laden aerosols are most concentrated at the source; they then diffuse and dilute with distance, making long-distance transmission rare in well-ventilated spaces. The primary risk factors for nosocomial transmission are community incidence rates, viral load, symptoms, proximity, duration of exposure, and poor ventilation. Failure to appreciate these factors may lead to underappreciation of some risks (for example, overestimation of the protection provided by medical masks, insufficient attention to ventilation) or misallocation of limited resources (for example, reserving N95 respirators and negative-pressure rooms only for aerosol-generating procedures or requiring negative-pressure rooms for all patients with SARS-CoV-2 infection regardless of stage of illness). Enhanced understanding of the factors governing respiratory pathogen transmission may inform the development of more effective policies to prevent nosocomial transmission of respiratory pathogens.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland (D.K.M.)
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Meghan A Baker
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland (S.L.)
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13
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Sehgal NJ, Milton DK. Applying the Hierarchy of Controls: What Occupational Safety Can Teach us About Safely Navigating the Next Phase of the Global COVID-19 Pandemic. Front Public Health 2021; 9:747894. [PMID: 34805071 PMCID: PMC8602064 DOI: 10.3389/fpubh.2021.747894] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/11/2021] [Indexed: 12/21/2022] Open
Abstract
Eighteen months into the COVID-19 pandemic, and as the world struggles with global vaccine equity, emerging variants, and the reality that eradication is years away at soonest, we add to notion of “layered defenses” proposing a conceptual model for better understanding the differential applicability and effectiveness of precautions against SARS-CoV-2 transmission. The prevailing adaptation of Reason's Swiss cheese model conceives of all defensive layers as equally protective, when in reality some are more effective than others. Adapting the hierarchy of controls framework from occupational safety provides a better framework for understanding the relative benefit of different hazard control strategies to minimize the spread of SARS-CoV-2.
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Affiliation(s)
- Neil J Sehgal
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD, United States
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, United States
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14
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Stockman T, Zhu S, Kumar A, Wang L, Patel S, Weaver J, Spede M, Milton DK, Hertzberg J, Toohey D, Vance M, Srebric J, Miller SL. Measurements and Simulations of Aerosol Released while Singing and Playing Wind Instruments. ACS Environ Au 2021; 1:71-84. [PMID: 37155479 PMCID: PMC8525345 DOI: 10.1021/acsenvironau.1c00007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Outbreaks from choir performances, such as the Skagit Valley Choir, showed that singing brings potential risk of COVID-19 infection. There is less known about the risks of airborne infection from other musical performances, such as playing wind instruments or performing theater. In addition, it is important to understand methods that can be used to reduce infection risk. In this study, we used a variety of methods, including flow visualization, aerosol and CO2 measurements, and computational fluid dynamics (CFD) modeling to understand the different components that can lead to transmission risk from musical performance and risk mitigation. This study was possible because of a partnership across academic departments and institutions and collaboration with the National Federation of State High School Associations and the College Band Directors National Association. The interdisciplinary team enabled us to understand the various aspects of aerosol transmission risk from musical performance and to quickly implement strategies in music classrooms during the COVID-19 pandemic. We found that plumes from musical performance were highly directional, unsteady and varied considerably in time and space. Aerosol number concentration measured at the bell of the clarinet was comparable to that of singing. Face and bell masks attenuated plume velocities and lengths and decreased aerosol concentrations measured in front of the masks. CFD modeling showed differences between indoor and outdoor environments and that the lowest risk of airborne COVID-19 infection occurred at less than 30 min of exposure indoors and less than 60 min outdoors.
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Affiliation(s)
- Tehya Stockman
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, Boulder, Colorado 80309, United States
| | - Shengwei Zhu
- Department of Mechanical Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Abhishek Kumar
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado 80309, United States
| | - Lingzhe Wang
- Department of Mechanical Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Sameer Patel
- Department of Civil Engineering, Indian Institute of Technology, Gandhinagar, Gujrat 382355, India
| | - James Weaver
- National Federation of State High School Associations, Indianapolis, Indiana 46402, United States
| | - Mark Spede
- Department of Performing Arts, Clemson University, Clemson, South Carolina 29634, United States
| | - Donald K. Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland 20740, United States
| | - Jean Hertzberg
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado 80309, United States
| | - Darin Toohey
- Department of Atmospheric and Oceanic Sciences, University of Colorado Boulder, Boulder, Colorado 80309, United States
| | - Marina Vance
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado 80309, United States
| | - Jelena Srebric
- Department of Mechanical Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Shelly L. Miller
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado 80309, United States
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15
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Xiao J, de Mesquita JB, Leung NHL, Adenaiye O, Tai S, Frieman MB, Hong F, Chu DKW, Ip DKM, Cowling BJ, Milton DK. Viral RNA and infectious influenza virus on mobile phones of influenza patients in Hong Kong and the United States. J Infect Dis 2021; 224:1730-1734. [PMID: 34534320 DOI: 10.1093/infdis/jiab464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
Mobile phones are among the most highly touched personal objects. As part of a broader study on the contribution of fomites to influenza transmission, between 2017-19, we swabbed mobile phones from 138 influenza patients in two locations. Influenza viral RNA detection rates were 23% (23/99) and 36% (14/39) in Hong Kong and Maryland, respectively. In Hong Kong, infectious influenza virus was recovered from 3/23 mobile phones. Mobile phone influenza contamination was positively associated with upper-respiratory viral load and negatively associated with age. Cleaning personal objects of influenza patients should be recommended and individuals should avoid sharing objects with influenza patients.
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Affiliation(s)
- Jingyi Xiao
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China
| | - Jacob Bueno de Mesquita
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Nancy H L Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China
| | - Oluwasanmi Adenaiye
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Sheldon Tai
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Matthew B Frieman
- Department of Microbiology and Immunology, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Filbert Hong
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Daniel K W Chu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China
| | - Dennis K M Ip
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China.,Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
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16
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Coleman KK, Tay DJW, Sen Tan K, Ong SWX, Son TT, Koh MH, Chin YQ, Nasir H, Mak TM, Chu JJH, Milton DK, Chow VTK, Tambyah PA, Chen M, Wai TK. Viral Load of SARS-CoV-2 in Respiratory Aerosols Emitted by COVID-19 Patients while Breathing, Talking, and Singing. Clin Infect Dis 2021; 74:1722-1728. [PMID: 34358292 PMCID: PMC8436389 DOI: 10.1093/cid/ciab691] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 11/14/2022] Open
Abstract
Background Multiple SARS-CoV-2 superspreading events suggest that aerosols play an important role in driving the COVID-19 pandemic. To better understand how airborne SARS-CoV-2 transmission occurs, we sought to determine viral loads within coarse (>5μm) and fine (≤5μm) respiratory aerosols produced when breathing, talking, and singing. Methods Using a G-II exhaled breath collector, we measured viral RNA in coarse and fine respiratory aerosols emitted by COVID-19 patients during 30 minutes of breathing, 15 minutes of talking, and 15 minutes of singing. Results Thirteen participants (59%) emitted detectable levels of SARS-CoV-2 RNA in respiratory aerosols, including 3 asymptomatic and 1 presymptomatic patient. Viral loads ranged from 63–5,821 N gene copies per expiratory activity per participant, with high person-to-person variation. Patients earlier in illness were more likely to emit detectable RNA. Two participants, sampled on day 3 of illness, accounted for 52% of the total viral load. Overall, 94% of SARS-CoV-2 RNA copies were emitted by talking and singing. Interestingly, 7 participants emitted more virus from talking than singing. Overall, fine aerosols constituted 85% of the viral load detected in our study. Virus cultures were negative. Conclusions Fine aerosols produced by talking and singing contain more SARS-CoV-2 copies than coarse aerosols and may play a significant role in SARS-CoV-2 transmission. Exposure to fine aerosols, especially indoors, should be mitigated. Isolating viable SARS-CoV-2 from respiratory aerosol samples remains challenging, and whether this can be more easily accomplished for emerging SARS-CoV-2 variants is an urgent enquiry necessitating larger-scale studies.
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Affiliation(s)
- Kristen K Coleman
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Douglas Jie Wen Tay
- Department of the Built Environment, National University of Singapore, Singapore
| | - Kai Sen Tan
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.,Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.,Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.,Biosafety Level 3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Sean Wei Xiang Ong
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Than The Son
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore.,Department of the Built Environment, National University of Singapore, Singapore
| | - Ming Hui Koh
- Department of the Built Environment, National University of Singapore, Singapore
| | - Yi Qing Chin
- National Centre for Infectious Diseases, Singapore
| | - Haziq Nasir
- Division of Infectious Diseases, Department of Medicine, National University Health System, National University of Singapore, Singapore
| | - Tze Minn Mak
- National Centre for Infectious Diseases, Singapore
| | - Justin Jang Hann Chu
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.,Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.,Biosafety Level 3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.,Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, USA
| | - Vincent T K Chow
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.,Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Paul Anantharajah Tambyah
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.,Division of Infectious Diseases, Department of Medicine, National University Health System, National University of Singapore, Singapore
| | - Mark Chen
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Tham Kwok Wai
- Department of the Built Environment, National University of Singapore, Singapore
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17
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Ye Z, Ke H, Chen S, Cruz-Cano R, He X, Zhang J, Dorgan J, Milton DK, Ma T. Biomarker Categorization in Transcriptomic Meta-Analysis by Concordant Patterns With Application to Pan-Cancer Studies. Front Genet 2021; 12:651546. [PMID: 34276766 PMCID: PMC8283696 DOI: 10.3389/fgene.2021.651546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/28/2021] [Indexed: 01/21/2023] Open
Abstract
With the increasing availability and dropping cost of high-throughput technology in recent years, many-omics datasets have accumulated in the public domain. Combining multiple transcriptomic studies on related hypothesis via meta-analysis can improve statistical power and reproducibility over single studies. For differential expression (DE) analysis, biomarker categorization by DE pattern across studies is a natural but critical task following biomarker detection to help explain between study heterogeneity and classify biomarkers into categories with potentially related functionality. In this paper, we propose a novel meta-analysis method to categorize biomarkers by simultaneously considering the concordant pattern and the biological and statistical significance across studies. Biomarkers with the same DE pattern can be analyzed together in downstream pathway enrichment analysis. In the presence of different types of transcripts (e.g., mRNA, miRNA, and lncRNA, etc.), integrative analysis including miRNA/lncRNA target enrichment analysis and miRNA-mRNA and lncRNA-mRNA causal regulatory network analysis can be conducted jointly on all the transcripts of the same category. We applied our method to two Pan-cancer transcriptomic study examples with single or multiple types of transcripts available. Targeted downstream analysis identified categories of biomarkers with unique functionality and regulatory relationships that motivate new hypothesis in Pan-cancer analysis.
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Affiliation(s)
- Zhenyao Ye
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, College Park, MD, United States
| | - Hongjie Ke
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, College Park, MD, United States
| | - Shuo Chen
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Raul Cruz-Cano
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, College Park, MD, United States
| | - Xin He
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, College Park, MD, United States
| | - Jing Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, College Park, MD, United States
| | - Joanne Dorgan
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, College Park, MD, United States
| | - Tianzhou Ma
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, College Park, MD, United States
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18
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Morawska L, Allen J, Bahnfleth W, Bluyssen PM, Boerstra A, Buonanno G, Cao J, Dancer SJ, Floto A, Franchimon F, Greenhalgh T, Haworth C, Hogeling J, Isaxon C, Jimenez JL, Kurnitski J, Li Y, Loomans M, Marks G, Marr LC, Mazzarella L, Melikov AK, Miller S, Milton DK, Nazaroff W, Nielsen PV, Noakes C, Peccia J, Prather K, Querol X, Sekhar C, Seppänen O, Tanabe SI, Tang JW, Tellier R, Tham KW, Wargocki P, Wierzbicka A, Yao M. A paradigm shift to combat indoor respiratory infection. Science 2021; 372:689-691. [PMID: 33986171 DOI: 10.1126/science.abg2025] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Joseph Allen
- Affiliations are listed in the supplementary materials
| | | | | | - Atze Boerstra
- Affiliations are listed in the supplementary materials
| | | | - Junji Cao
- Affiliations are listed in the supplementary materials
| | | | - Andres Floto
- Affiliations are listed in the supplementary materials
| | | | | | | | - Jaap Hogeling
- Affiliations are listed in the supplementary materials
| | | | | | | | - Yuguo Li
- Affiliations are listed in the supplementary materials
| | | | - Guy Marks
- Affiliations are listed in the supplementary materials
| | - Linsey C Marr
- Affiliations are listed in the supplementary materials
| | | | | | - Shelly Miller
- Affiliations are listed in the supplementary materials
| | | | | | | | | | - Jordan Peccia
- Affiliations are listed in the supplementary materials
| | - Kim Prather
- Affiliations are listed in the supplementary materials
| | - Xavier Querol
- Affiliations are listed in the supplementary materials
| | | | - Olli Seppänen
- Affiliations are listed in the supplementary materials
| | | | - Julian W Tang
- Affiliations are listed in the supplementary materials
| | | | - Kwok Wai Tham
- Affiliations are listed in the supplementary materials
| | | | | | - Maosheng Yao
- Affiliations are listed in the supplementary materials
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19
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Adenaiye O, Bueno de Mesquita PJ, Wu Q, Hong F, Lai J, Chen S, Milton DK. The effect of COVID-19 stay-at-home order and campus closure on the prevalence of acute respiratory infection symptoms in college campus cohorts. Influenza Other Respir Viruses 2021; 15:331-335. [PMID: 33665959 PMCID: PMC8014755 DOI: 10.1111/irv.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 11/29/2022] Open
Abstract
Evaluation of population-based COVID-19 control measures informs strategies to quell the current pandemic and reduce the impact of those yet to come. Effective COVID-19 control measures may simultaneously reduce the incidence of other acute respiratory infections (ARIs) due to shared transmission modalities. To assess the impact of stay-at-home orders and other physical distancing measures on the prevalence of ARI-related symptoms, we compared symptoms reported by prospective college cohorts enrolled during two consecutive academic years. ARI-related symptoms declined following campus closure and implementation of stay-at-home orders, demonstrating the impact of population-based physical distancing measures on control of a broad range of respiratory infections.
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Affiliation(s)
- Oluwasanmi Adenaiye
- Maryland Institute for Applied Environmental HealthUniversity of MarylandCollege ParkMDUSA
| | | | - Qiong Wu
- Department of MathematicsUniversity of MarylandCollege ParkMDUSA
| | - Filbert Hong
- Maryland Institute for Applied Environmental HealthUniversity of MarylandCollege ParkMDUSA
| | - Jianyu Lai
- Maryland Institute for Applied Environmental HealthUniversity of MarylandCollege ParkMDUSA
- Department of Epidemiology and BiostatisticsUniversity of MarylandCollege ParkMDUSA
| | - Shuo Chen
- Division of Biostatistics and BioinformaticsSchool of MedicineUniversity of MarylandBaltimoreMDUSA
| | - Donald K. Milton
- Maryland Institute for Applied Environmental HealthUniversity of MarylandCollege ParkMDUSA
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20
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Wu Q, Ma T, Liu Q, Milton DK, Zhang Y, Chen S. ICN: Extracting interconnected communities in gene Co-expression networks. Bioinformatics 2021; 37:btab047. [PMID: 33508087 PMCID: PMC8337009 DOI: 10.1093/bioinformatics/btab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 11/13/2022] Open
Abstract
MOTIVATION The analysis of gene co-expression network (GCN) is critical in examining the gene-gene interactions and learning the underlying complex yet highly organized gene regulatory mechanisms. Numerous clustering methods have been developed to detect communities of co-expressed genes in the large network. The assumed independent community structure, however, can be oversimplified and may not adequately characterize the complex biological processes. RESULTS We develop a new computational package to extract interconnected communities from gene co-expression network. We consider a pair of communities be interconnected if a subset of genes from one community is correlated with a subset of genes from another community. The interconnected community structure is more flexible and provides a better fit to the empirical co-expression matrix. To overcome the computational challenges, we develop efficient algorithms by leveraging advanced graph norm shrinkage approach. We validate and show the advantage of our method by extensive simulation studies. We then apply our interconnected community detection method to an RNA-seq data from The Cancer Genome Atlas (TCGA) Acute Myeloid Leukemia (AML) study and identify essential interacting biological pathways related to the immune evasion mechanism of tumor cells. AVAILABILITY The software is available at Github: https://github.com/qwu1221/ICN and Figshare: https://figshare.com/articles/software/ICN-package/13229093. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Qiong Wu
- Department of Mathematics, University of Maryland, College Park, MD 20740, USA
| | - Tianzhou Ma
- Department of Biostatistics and Bioinformatics, School of Public Health, University of Maryland, College Park, MD 20740, USA
| | - Qingzhi Liu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Donald K Milton
- Department of Biostatistics and Bioinformatics, School of Public Health, University of Maryland, College Park, MD 20740, USA
| | - Yuan Zhang
- Department of Statistics, Ohio State University, Columbus, OH 43210, USA
| | - Shuo Chen
- Department of Epidemiology and Public Health, Division of Biostatistics and Bioinformatics, School of Medicine, University of Maryland, Baltimore, MD 43210, USA
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21
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de Assis RR, Jain A, Nakajima R, Jasinskas A, Felgner J, Obiero JM, Norris PJ, Stone M, Simmons G, Bagri A, Irsch J, Schreiber M, Buser A, Holbro A, Battegay M, Hosimer P, Noesen C, Adenaiye O, Tai S, Hong F, Milton DK, Davies DH, Contestable P, Corash LM, Busch MP, Felgner PL, Khan S. Analysis of SARS-CoV-2 antibodies in COVID-19 convalescent blood using a coronavirus antigen microarray. Nat Commun 2021; 12:6. [PMID: 33397903 PMCID: PMC7782488 DOI: 10.1038/s41467-020-20095-2] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 11/10/2020] [Indexed: 01/28/2023] Open
Abstract
The current practice for diagnosis of COVID-19, based on SARS-CoV-2 PCR testing of pharyngeal or respiratory specimens in a symptomatic patient at high epidemiologic risk, likely underestimates the true prevalence of infection. Serologic methods can more accurately estimate the disease burden by detecting infections missed by the limited testing performed to date. Here, we describe the validation of a coronavirus antigen microarray containing immunologically significant antigens from SARS-CoV-2, in addition to SARS-CoV, MERS-CoV, common human coronavirus strains, and other common respiratory viruses. A comparison of antibody profiles detected on the array from control sera collected prior to the SARS-CoV-2 pandemic versus convalescent blood specimens from virologically confirmed COVID-19 cases demonstrates near complete discrimination of these two groups, with improved performance from use of antigen combinations that include both spike protein and nucleoprotein. This array can be used as a diagnostic tool, as an epidemiologic tool to more accurately estimate the disease burden of COVID-19, and as a research tool to correlate antibody responses with clinical outcomes.
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Affiliation(s)
- Rafael R de Assis
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | - Aarti Jain
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | - Rie Nakajima
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | - Algis Jasinskas
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | - Jiin Felgner
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | - Joshua M Obiero
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | - Philip J Norris
- Vitalant Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Mars Stone
- Vitalant Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Graham Simmons
- Vitalant Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | | | | | - Martin Schreiber
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Andreas Buser
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Holbro
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Manuel Battegay
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Oluwasanmi Adenaiye
- Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Sheldon Tai
- Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Filbert Hong
- Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Donald K Milton
- Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - D Huw Davies
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | | | | | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Philip L Felgner
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, USA
| | - Saahir Khan
- Division of Infectious Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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22
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Bueno de Mesquita PJ, Nguyen‐Van‐Tam J, Killingley B, Enstone J, Lambkin‐Williams R, Gilbert AS, Mann A, Forni J, Yan J, Pantelic J, Grantham ML, Milton DK. Influenza A (H3) illness and viral aerosol shedding from symptomatic naturally infected and experimentally infected cases. Influenza Other Respir Viruses 2021; 15:154-163. [PMID: 32705798 PMCID: PMC7767952 DOI: 10.1111/irv.12790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND It has long been known that nasal inoculation with influenza A virus produces asymptomatic to febrile infections. Uncertainty persists about whether these infections are sufficiently similar to natural infections for studying human-to-human transmission. METHODS We compared influenza A viral aerosol shedding from volunteers nasally inoculated with A/Wisconsin/2005 (H3N2) and college community adults naturally infected with influenza A/H3N2 (2012-2013), selected for influenza-like illness with objectively measured fever or a positive Quidel QuickVue A&B test. Propensity scores were used to control for differences in symptom presentation observed between experimentally and naturally infected groups. RESULTS Eleven (28%) experimental and 71 (86%) natural cases shed into fine particle aerosols (P < .001). The geometric mean (geometric standard deviation) for viral positive fine aerosol samples from experimental and natural cases was 5.1E + 3 (4.72) and 3.9E + 4 (15.12) RNA copies/half hour, respectively. The 95th percentile shedding rate was 2.4 log10 greater for naturally infected cases (1.4E + 07 vs 7.4E + 04). Certain influenza-like illness-related symptoms were associated with viral aerosol shedding. The almost complete lack of symptom severity distributional overlap between groups did not support propensity score-adjusted shedding comparisons. CONCLUSIONS Due to selection bias, the natural and experimental infections had limited symptom severity distributional overlap precluding valid, propensity score-adjusted comparison. Relative to the symptomatic naturally infected cases, where high aerosol shedders were found, experimental cases did not produce high aerosol shedders. Studying the frequency of aerosol shedding at the highest observed levels in natural infections without selection on symptoms or fever would support helpful comparisons.
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Affiliation(s)
- Paul Jacob Bueno de Mesquita
- University of Maryland School of Public HealthMaryland Institute for Applied Environmental HealthCollege ParkMDUSA
| | - Jonathan Nguyen‐Van‐Tam
- Division of Epidemiology and Public HeathHealth Protection and Influenza Research GroupUniversity of Nottingham School of MedicineNottinghamUK
| | - Ben Killingley
- Division of Epidemiology and Public HeathHealth Protection and Influenza Research GroupUniversity of Nottingham School of MedicineNottinghamUK
| | - Joanne Enstone
- Division of Epidemiology and Public HeathHealth Protection and Influenza Research GroupUniversity of Nottingham School of MedicineNottinghamUK
| | | | | | | | - John Forni
- hVIVOLondonUK
- Present address:
Department of Acute and Specialty CareMSDLondonUK
| | - Jing Yan
- University of Maryland School of Public HealthMaryland Institute for Applied Environmental HealthCollege ParkMDUSA
| | - Jovan Pantelic
- University of Maryland School of Public HealthMaryland Institute for Applied Environmental HealthCollege ParkMDUSA
- Present address:
Center for the Built EnvironmentUniversity of CaliforniaBerkeleyCAUSA
| | - Michael L. Grantham
- University of Maryland School of Public HealthMaryland Institute for Applied Environmental HealthCollege ParkMDUSA
- Present address:
Missouri Western State UniversitySt. JosephMOUSA
| | - Donald K. Milton
- University of Maryland School of Public HealthMaryland Institute for Applied Environmental HealthCollege ParkMDUSA
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23
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Morawska L, Milton DK. It Is Time to Address Airborne Transmission of Coronavirus Disease 2019 (COVID-19). Clin Infect Dis 2020; 71:2311-2313. [PMID: 32628269 PMCID: PMC7454469 DOI: 10.1093/cid/ciaa939] [Citation(s) in RCA: 537] [Impact Index Per Article: 134.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lidia Morawska
- International Laboratory for Air Quality and Heath, WHO Collaborating Centre, Queensland University of Technology, Brisbane, Australia
| | - Donald K Milton
- Institute for Applied Environmental Health, University of Maryland School of Public Health, Maryland, USA
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24
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Affiliation(s)
- Lidia Morawska
- International Laboratory for Air Quality and Heath, WHO Collaborating Centre, Queensland University of Technology, Brisbane, Australia
| | - Donald K Milton
- Institute for Applied Environmental Health, University of Maryland School of Public Health, Maryland, USA
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25
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Bueno de Mesquita PJ, Noakes CJ, Milton DK. Quantitative aerobiologic analysis of an influenza human challenge-transmission trial. Indoor Air 2020; 30:1189-1198. [PMID: 32542890 PMCID: PMC7687273 DOI: 10.1111/ina.12701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 05/05/2023]
Abstract
Despite evidence that airborne transmission contributes to influenza epidemics, limited knowledge of the infectiousness of human influenza cases hinders pandemic preparedness. We used airborne viral source strength and indoor CO2 monitoring from the largest human influenza challenge-transmission trial (EMIT: Evaluating Modes of Influenza Transmission, ClinicalTrials.gov number NCT01710111) to compute an airborne infectious dose generation rate q = 0.11 (95% CI 0.088, 0.12)/h and calculate the quantity of airborne virus per infectious dose σ = 1.4E + 5 RNA copies/quantum (95% CI 9.9E + 4, 1.8E + 5). We then compared these calculated values to available data on influenza airborne infectious dose from several previous studies, and applied the values to dormitory room environments to predict probability of transmission between roommates. Transmission risk from typical, moderately to severely symptomatic influenza cases is dramatically decreased by exposure reduction via increasing indoor air ventilation. The minority of cases who shed the most virus (ie, supershedders) may pose great risk even in well-ventilated spaces. Our modeling method and estimated infectiousness provide a ground work for (a) epidemiologic studies of transmission in non-experimental settings and (b) evaluation of the extent to which airborne exposure control strategies could limit transmission risk.
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Affiliation(s)
| | | | - Donald K. Milton
- Maryland Institute for Applied Environmental HealthUniversity of MarylandCollege ParkMarylandUSA
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26
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Affiliation(s)
- Kimberly A Prather
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA.
| | - Linsey C Marr
- Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA.
| | - Robert T Schooley
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Melissa A McDiarmid
- Division of Occupational & Environmental Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Mary E Wilson
- School of Medicine, University of California, San Francisco, CA 94143, USA.,Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Donald K Milton
- Institute for Applied Environmental Health, University of Maryland, College Park, MD 20742, USA
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27
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Morawska L, Tang JW, Bahnfleth W, Bluyssen PM, Boerstra A, Buonanno G, Cao J, Dancer S, Floto A, Franchimon F, Haworth C, Hogeling J, Isaxon C, Jimenez JL, Kurnitski J, Li Y, Loomans M, Marks G, Marr LC, Mazzarella L, Melikov AK, Miller S, Milton DK, Nazaroff W, Nielsen PV, Noakes C, Peccia J, Querol X, Sekhar C, Seppänen O, Tanabe SI, Tellier R, Tham KW, Wargocki P, Wierzbicka A, Yao M. How can airborne transmission of COVID-19 indoors be minimised? Environ Int 2020; 142:105832. [PMID: 32521345 PMCID: PMC7250761 DOI: 10.1016/j.envint.2020.105832] [Citation(s) in RCA: 544] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 05/17/2023]
Abstract
During the rapid rise in COVID-19 illnesses and deaths globally, and notwithstanding recommended precautions, questions are voiced about routes of transmission for this pandemic disease. Inhaling small airborne droplets is probable as a third route of infection, in addition to more widely recognized transmission via larger respiratory droplets and direct contact with infected people or contaminated surfaces. While uncertainties remain regarding the relative contributions of the different transmission pathways, we argue that existing evidence is sufficiently strong to warrant engineering controls targeting airborne transmission as part of an overall strategy to limit infection risk indoors. Appropriate building engineering controls include sufficient and effective ventilation, possibly enhanced by particle filtration and air disinfection, avoiding air recirculation and avoiding overcrowding. Often, such measures can be easily implemented and without much cost, but if only they are recognised as significant in contributing to infection control goals. We believe that the use of engineering controls in public buildings, including hospitals, shops, offices, schools, kindergartens, libraries, restaurants, cruise ships, elevators, conference rooms or public transport, in parallel with effective application of other controls (including isolation and quarantine, social distancing and hand hygiene), would be an additional important measure globally to reduce the likelihood of transmission and thereby protect healthcare workers, patients and the general public.
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Affiliation(s)
- Lidia Morawska
- International Laboratory for Air Quality and Heath (ILAQH), WHO Collaborating Centre for Air Quality and Health, School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Julian W Tang
- Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - William Bahnfleth
- Department of Architectural Engineering, The Pennsylvania State University, USA
| | - Philomena M Bluyssen
- Faculty of Architecture and the Built Environment, Delft University of Technology, the Netherlands
| | - Atze Boerstra
- REHVA (Federation of European Heating, Ventilation and Air Conditioning Associations), BBA Binnenmilieu, the Netherlands
| | - Giorgio Buonanno
- Department if Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, Italy
| | - Junji Cao
- Key Lab of Aerosol Chemistry and Physics Chinese Academy of Sciences, Xi'an, Beijing, China
| | - Stephanie Dancer
- Edinburgh Napier University and NHS Lanarkshire, Scotland, United Kingdom
| | - Andres Floto
- Department of Medicine, University of Cambridge, United Kingdom
| | | | - Charles Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jaap Hogeling
- International Standards at ISSO, ISSO International Project, the Netherlands
| | | | - Jose L Jimenez
- Department of Chemistry, and Cooperative Institute for Research in Environmental Sciences (CIRES) University of Colorado, Boulder, USA
| | - Jarek Kurnitski
- REHVA Technology and Research Committee, Tallinn University of Technology, Estonia
| | - Yuguo Li
- Department of Mechancal Engineering, Hong Kong University, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Marcel Loomans
- Department of the Built Environment, Eindhoven University of Technology (TU/e), the Netherlands
| | - Guy Marks
- Centre for Air quality Research and evaluation (CAR), University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | | | | | - Arsen Krikor Melikov
- International Centre for Indoor Environment and Energy, Department of Civil Engineering, Technical University of Denmark, Denmark
| | - Shelly Miller
- Mechanical Engineering, University of Colorado, Boulder, USA
| | - Donald K Milton
- Environmental Health, School of Public Health, University of Maryland, USA
| | - William Nazaroff
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
| | - Peter V Nielsen
- Faculty of Engineering and Science, Department of Civil Engineering, Aalborg University, Denmark
| | - Catherine Noakes
- School of Civil Engineering, University of Leeds, United Kingdom
| | | | - Xavier Querol
- Institute of Environmental Assessment and Water Research, Department of Geosciences, Spanish National Research Council, Barcelona, Spain
| | - Chandra Sekhar
- Department of Building, National University of Singapore, Singapore
| | | | | | | | - Kwok Wai Tham
- Department of Building, National University of Singapore, Singapore
| | - Pawel Wargocki
- International Centre for Indoor Environment and Energy, Department of Civil Engineering, Technical University of Denmark, Denmark
| | | | - Maosheng Yao
- College of Environmental Sciences and Engineering, Peking University, Beijing, China
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28
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Affiliation(s)
- Lidia Morawska
- International Laboratory for Air Quality and Heath, World Health Organization Collaborating Centre, Queensland University of Technology, Brisbane, Australia
| | - Donald K Milton
- Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
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29
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Affiliation(s)
- Donald K Milton
- Institute for Applied Environmental Health, University of Maryland School of Public Health, Maryland, USA,Correspondence: Donald K. Milton, MD, Dr PH, Institute for Applied Environmental Health, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD 20782. E-mail:
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30
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Nguyen-Van-Tam JS, Killingley B, Enstone J, Hewitt M, Pantelic J, Grantham ML, Bueno de Mesquita PJ, Lambkin-Williams R, Gilbert A, Mann A, Forni J, Noakes CJ, Levine MZ, Berman L, Lindstrom S, Cauchemez S, Bischoff W, Tellier R, Milton DK. Minimal transmission in an influenza A (H3N2) human challenge-transmission model within a controlled exposure environment. PLoS Pathog 2020; 16:e1008704. [PMID: 32658939 PMCID: PMC7390452 DOI: 10.1371/journal.ppat.1008704] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/29/2020] [Accepted: 06/14/2020] [Indexed: 12/22/2022] Open
Abstract
Uncertainty about the importance of influenza transmission by airborne droplet nuclei generates controversy for infection control. Human challenge-transmission studies have been supported as the most promising approach to fill this knowledge gap. Healthy, seronegative volunteer ‘Donors’ (n = 52) were randomly selected for intranasal challenge with influenza A/Wisconsin/67/2005 (H3N2). ‘Recipients’ randomized to Intervention (IR, n = 40) or Control (CR, n = 35) groups were exposed to Donors for four days. IRs wore face shields and hand sanitized frequently to limit large droplet and contact transmission. One transmitted infection was confirmed by serology in a CR, yielding a secondary attack rate of 2.9% among CR, 0% in IR (p = 0.47 for group difference), and 1.3% overall, significantly less than 16% (p<0.001) expected based on a proof-of-concept study secondary attack rate and considering that there were twice as many Donors and days of exposure. The main difference between these studies was mechanical building ventilation in the follow-on study, suggesting a possible role for aerosols. Understanding the relative importance of influenza modes of transmission informs strategic use of preventive measures to reduce influenza risk in high-risk settings such as hospitals and is important for pandemic preparedness. Given the increasing evidence from epidemiological modelling, exhaled viral aerosol, and aerobiological survival studies supporting a role for airborne transmission and the potential benefit of respirators (and other precautions designed to prevent inhalation of aerosols) versus surgical masks (mainly effective for reducing exposure to large droplets) to protect healthcare workers, more studies are needed to evaluate the extent of risk posed airborne versus contact and large droplet spray transmission modes. New human challenge-transmission studies should be carefully designed to overcome limitations encountered in the current study. The low secondary attack rate reported herein also suggests that the current challenge-transmission model may no longer be a more promising approach to resolving questions about transmission modes than community-based studies employing environmental monitoring and newer, state-of-the-art deep sequencing-based molecular epidemiological methods.
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Affiliation(s)
- Jonathan S. Nguyen-Van-Tam
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Heath, University of Nottingham School of Medicine, Nottingham, United Kingdom
| | - Ben Killingley
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Heath, University of Nottingham School of Medicine, Nottingham, United Kingdom
- * E-mail:
| | - Joanne Enstone
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Heath, University of Nottingham School of Medicine, Nottingham, United Kingdom
| | - Michael Hewitt
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Heath, University of Nottingham School of Medicine, Nottingham, United Kingdom
| | - Jovan Pantelic
- University of Maryland School of Public Health, Maryland Institute for Applied Environmental Health, College Park, Maryland, United States of America
| | - Michael L. Grantham
- University of Maryland School of Public Health, Maryland Institute for Applied Environmental Health, College Park, Maryland, United States of America
| | - P. Jacob Bueno de Mesquita
- University of Maryland School of Public Health, Maryland Institute for Applied Environmental Health, College Park, Maryland, United States of America
| | | | | | | | | | | | - Min Z. Levine
- Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia, United States of America
| | - LaShondra Berman
- Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia, United States of America
| | - Stephen Lindstrom
- Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia, United States of America
| | - Simon Cauchemez
- Imperial College London, MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, London, United Kingdom
| | - Werner Bischoff
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | | | - Donald K. Milton
- University of Maryland School of Public Health, Maryland Institute for Applied Environmental Health, College Park, Maryland, United States of America
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31
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Chia PY, Coleman KK, Tan YK, Ong SWX, Gum M, Lau SK, Lim XF, Lim AS, Sutjipto S, Lee PH, Son TT, Young BE, Milton DK, Gray GC, Schuster S, Barkham T, De PP, Vasoo S, Chan M, Ang BSP, Tan BH, Leo YS, Ng OT, Wong MSY, Marimuthu K. Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients. Nat Commun 2020; 11:2800. [PMID: 32472043 DOI: 10.1101/2020.03.29.20046557] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/18/2020] [Indexed: 05/20/2023] Open
Abstract
Understanding the particle size distribution in the air and patterns of environmental contamination of SARS-CoV-2 is essential for infection prevention policies. Here we screen surface and air samples from hospital rooms of COVID-19 patients for SARS-CoV-2 RNA. Environmental sampling is conducted in three airborne infection isolation rooms (AIIRs) in the ICU and 27 AIIRs in the general ward. 245 surface samples are collected. 56.7% of rooms have at least one environmental surface contaminated. High touch surface contamination is shown in ten (66.7%) out of 15 patients in the first week of illness, and three (20%) beyond the first week of illness (p = 0.01, χ2 test). Air sampling is performed in three of the 27 AIIRs in the general ward, and detects SARS-CoV-2 PCR-positive particles of sizes >4 µm and 1-4 µm in two rooms, despite these rooms having 12 air changes per hour. This warrants further study of the airborne transmission potential of SARS-CoV-2.
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Affiliation(s)
- Po Ying Chia
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | | | - Sean Wei Xiang Ong
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Marcus Gum
- DSO National Laboratories, Singapore, Singapore
| | | | | | - Ai Sim Lim
- DSO National Laboratories, Singapore, Singapore
| | - Stephanie Sutjipto
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Pei Hua Lee
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Than The Son
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Gregory C Gray
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- School of Medicine and Global Health Institute, Duke University, Durham, NC, USA
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Stephan Schuster
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Timothy Barkham
- Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Partha Pratim De
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Monica Chan
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Brenda Sze Peng Ang
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Oon-Tek Ng
- National Centre for Infectious Diseases, Singapore, Singapore.
- Tan Tock Seng Hospital, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | | | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore, Singapore.
- Tan Tock Seng Hospital, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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32
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Leung NHL, Chu DKW, Shiu EYC, Chan KH, McDevitt JJ, Hau BJP, Yen HL, Li Y, Ip DKM, Peiris JSM, Seto WH, Leung GM, Milton DK, Cowling BJ. Author Correction: Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med 2020; 26:981. [PMID: 32461699 PMCID: PMC7252509 DOI: 10.1038/s41591-020-0946-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Nancy H L Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Daniel K W Chu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Eunice Y C Shiu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kwok-Hung Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - James J McDevitt
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Benien J P Hau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Hui-Ling Yen
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Dennis K M Ip
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - J S Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing-Hong Seto
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Pathology, Hong Kong Baptist Hospital, Hong Kong, China
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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33
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de Assis RR, Jain A, Nakajima R, Jasinskas A, Felgner J, Obiero JM, Adenaiye O, Tai S, Hong F, Norris PJ, Stone M, Simmons G, Bagri A, Schreiber M, Buser A, Holbro A, Battegay M, Hosimer P, Noesen C, Milton DK, Davies DH, Contestable P, Corash LM, Busch MP, Felgner PL, Khan S. Analysis of SARS-CoV-2 Antibodies in COVID-19 Convalescent Blood using a Coronavirus Antigen Microarray. bioRxiv 2020. [PMID: 32511302 PMCID: PMC7217240 DOI: 10.1101/2020.04.15.043364] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The current practice for diagnosis of COVID-19, based on SARS-CoV-2 PCR testing of pharyngeal or respiratory specimens in a symptomatic patient at high epidemiologic risk, likely underestimates the true prevalence of infection. Serologic methods can more accurately estimate the disease burden by detecting infections missed by the limited testing performed to date. Here, we describe the validation of a coronavirus antigen microarray containing immunologically significant antigens from SARS-CoV-2, in addition to SARS-CoV, MERS-CoV, common human coronavirus strains, and other common respiratory viruses. A comparison of antibody profiles detected on the array from control sera collected prior to the SARS-CoV-2 pandemic versus convalescent blood specimens from virologically confirmed COVID-19 cases demonstrates near complete discrimination of these two groups, with improved performance from use of antigen combinations that include both spike protein and nucleoprotein. This array can be used as a diagnostic tool, as an epidemiologic tool to more accurately estimate the disease burden of COVID-19, and as a research tool to correlate antibody responses with clinical outcomes.
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Affiliation(s)
- Rafael R de Assis
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA
| | - Aarti Jain
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA
| | - Rie Nakajima
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA
| | - Algis Jasinskas
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA
| | - Jiin Felgner
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA
| | - Joshua M Obiero
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA
| | - Oluwasanmi Adenaiye
- Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD
| | - Sheldon Tai
- Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD
| | - Filbert Hong
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA
| | - Philip J Norris
- Vitalant Research Institute, San Francisco, CA.,Department of Laboratory Medicine, University of California, San Francisco, CA
| | - Mars Stone
- Vitalant Research Institute, San Francisco, CA.,Department of Laboratory Medicine, University of California, San Francisco, CA
| | - Graham Simmons
- Vitalant Research Institute, San Francisco, CA.,Department of Laboratory Medicine, University of California, San Francisco, CA
| | | | - Martin Schreiber
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Andreas Buser
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Holbro
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Donald K Milton
- Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD
| | | | - D Huw Davies
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA
| | | | | | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA.,Department of Laboratory Medicine, University of California, San Francisco, CA
| | - Philip L Felgner
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA
| | - Saahir Khan
- Division of Infectious Diseases, Department of Medicine, University of California Irvine Health, Orange, CA
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34
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Leung NHL, Chu DKW, Shiu EYC, Chan KH, McDevitt JJ, Hau BJP, Yen HL, Li Y, Ip DKM, Peiris JSM, Seto WH, Leung GM, Milton DK, Cowling BJ. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med 2020. [PMID: 32371934 DOI: 10.21203/rs.3.rs-16836/v1] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
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Affiliation(s)
- Nancy H L Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Daniel K W Chu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Eunice Y C Shiu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kwok-Hung Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - James J McDevitt
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Benien J P Hau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Hui-Ling Yen
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Dennis K M Ip
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - J S Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing-Hong Seto
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Pathology, Hong Kong Baptist Hospital, Hong Kong, China
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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35
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Zhu S, Jenkins S, Addo K, Heidarinejad M, Romo SA, Layne A, Ehizibolo J, Dalgo D, Mattise NW, Hong F, Adenaiye OO, Bueno de Mesquita JP, Albert BJ, Washington-Lewis R, German J, Tai S, Youssefi S, Milton DK, Srebric J. Ventilation and laboratory confirmed acute respiratory infection (ARI) rates in college residence halls in College Park, Maryland. Environ Int 2020; 137:105537. [PMID: 32028176 PMCID: PMC7112667 DOI: 10.1016/j.envint.2020.105537] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/02/2020] [Accepted: 01/27/2020] [Indexed: 05/20/2023]
Abstract
Strategies to protect building occupants from the risk of acute respiratory infection (ARI) need to consider ventilation for its ability to dilute and remove indoor bioaerosols. Prior studies have described an association of increased self-reported colds and influenza-like symptoms with low ventilation but have not combined rigorous characterization of ventilation with assessment of laboratory confirmed infections. We report a study designed to fill this gap. We followed laboratory confirmed ARI rates and measured CO2 concentrations for four months during the winter-spring of 2018 in two campus residence halls: (1) a high ventilation building (HVB) with a dedicated outdoor air system that supplies 100% of outside air to each dormitory room, and (2) a low ventilation building (LVB) that relies on infiltration as ventilation. We enrolled 11 volunteers for a total of 522 person-days in the HVB and 109 volunteers for 6069 person-days in the LVB, and tested upper-respiratory swabs from symptomatic cases and their close contacts for the presence of 44 pathogens using a molecular assay. We observed one ARI case in the HVB (0.70/person-year) and 47 in the LVB (2.83/person-year). Simultaneously, 154 CO2 sensors distributed primarily in the dormitory rooms collected 668,390 useful data points from over 1 million recorded data points. Average and standard deviation of CO2 concentrations were 1230 ppm and 408 ppm in the HVB, and 1492 ppm and 837 ppm in the LVB, respectively. Importantly, this study developed and calibrated multi-zone models for the HVB with 229 zones and 983 airflow paths, and for the LVB with 529 zones and 1836 airflow paths by using a subset of CO2 data for model calibration. The models were used to calculate ventilation rates in the two buildings and potential for viral aerosol migration between rooms in the LVB. With doors and windows closed, the average ventilation rate was 12 L/s in the HVB dormitory rooms and 4 L/s in the LVB dormitory rooms. As a result, residents had on average 6.6 L/(s person) of outside air in the HVB and 2.3 L/(s person) in the LVB. LVB rooms located at the leeward side of the building had smaller average ventilation rates, as well as a somewhat higher ARI incidence rate and average CO2 concentrations when compared to those values in the rooms located at the windward side of the building. Average ventilation rates in twenty LVB dormitory rooms increased from 2.3 L/s to 7.5 L/s by opening windows, 3.6 L/s by opening doors, and 8.8 L/s by opening both windows and doors. Therefore, opening both windows and doors in the LVB dormitory rooms can increase ventilation rates to the levels comparable to those in the HVB. But it can also have a negative effect on thermal comfort due to low outdoor temperatures. Simulation results identified an aerobiologic pathway from a room occupied by an index case of influenza A to a room occupied by a possible secondary case.
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Affiliation(s)
- Shengwei Zhu
- University of Maryland, College Park, MD 20742, USA
| | - Sara Jenkins
- University of Maryland, College Park, MD 20742, USA
| | - Kofi Addo
- University of Maryland, College Park, MD 20742, USA
| | - Mohammad Heidarinejad
- University of Maryland, College Park, MD 20742, USA; Illinois Institute of Technology, Chicago, IL 60616, USA
| | | | - Avery Layne
- University of Maryland, College Park, MD 20742, USA
| | | | - Daniel Dalgo
- University of Maryland, College Park, MD 20742, USA
| | | | - Filbert Hong
- University of Maryland, College Park, MD 20742, USA
| | | | | | | | | | | | - Sheldon Tai
- University of Maryland, College Park, MD 20742, USA
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36
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Khan S, Nakajima R, Jain A, de Assis RR, Jasinskas A, Obiero JM, Adenaiye O, Tai S, Hong F, Milton DK, Davies H, Felgner PL. Analysis of Serologic Cross-Reactivity Between Common Human Coronaviruses and SARS-CoV-2 Using Coronavirus Antigen Microarray. bioRxiv 2020:2020.03.24.006544. [PMID: 32511324 PMCID: PMC7239054 DOI: 10.1101/2020.03.24.006544] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The current practice for diagnosis of SARS-CoV-2 infection relies on PCR testing of nasopharyngeal or respiratory specimens in a symptomatic patient at high epidemiologic risk. This testing strategy likely underestimates the true prevalence of infection, creating the need for serologic methods to detect infections missed by the limited testing to date. Here, we describe the development of a coronavirus antigen microarray containing immunologically significant antigens from SARS-CoV-2, in addition to SARS-CoV, MERS-CoV, common human coronavirus strains, and other common respiratory viruses. A preliminary study of human sera collected prior to the SARS-CoV-2 pandemic demonstrates overall high IgG reactivity to common human coronaviruses and low IgG reactivity to epidemic coronaviruses including SARS-CoV-2, with some cross-reactivity of conserved antigenic domains including S2 domain of spike protein and nucleocapsid protein. This array can be used to answer outstanding questions regarding SARS-CoV-2 infection, including whether baseline serology for other coronaviruses impacts disease course, how the antibody response to infection develops over time, and what antigens would be optimal for vaccine development.
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Affiliation(s)
- Saahir Khan
- Division of Infectious Diseases, Department of Medicine, University of California Irvine Health, Orange, CA
| | - Rie Nakajima
- Department of Physiology and Biophysics, School of Medicine, University of California Irvine, Irvine, CA
| | - Aarti Jain
- Department of Physiology and Biophysics, School of Medicine, University of California Irvine, Irvine, CA
| | - Rafael Ramiro de Assis
- Department of Physiology and Biophysics, School of Medicine, University of California Irvine, Irvine, CA
| | - Al Jasinskas
- Department of Physiology and Biophysics, School of Medicine, University of California Irvine, Irvine, CA
| | - Joshua M. Obiero
- Department of Physiology and Biophysics, School of Medicine, University of California Irvine, Irvine, CA
| | - Oluwasanmi Adenaiye
- Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD
| | - Sheldon Tai
- Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD
| | - Filbert Hong
- Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD
| | - Donald K. Milton
- Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD
| | - Huw Davies
- Department of Physiology and Biophysics, School of Medicine, University of California Irvine, Irvine, CA
| | - Philip L. Felgner
- Department of Physiology and Biophysics, School of Medicine, University of California Irvine, Irvine, CA
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37
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Fennelly KP, Acuna-Villaorduna C, Jones-Lopez E, Lindsley WG, Milton DK. Microbial Aerosols: New Diagnostic Specimens for Pulmonary Infections. Chest 2019; 157:540-546. [PMID: 31678308 DOI: 10.1016/j.chest.2019.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 01/20/2023] Open
Abstract
Pulmonary infections are important causes of global morbidity and mortality, but diagnostics are often limited by the ability to collect specimens easily, safely, and in a cost-effective manner. We review recent advances in the collection of infectious aerosols from patients with TB and with influenza. Although this research has been focused on assessing the infectious potential of such patients, we propose that these methods have the potential to lead to the use of patient-generated microbial aerosols as noninvasive diagnostic tests of disease and tests of infectiousness.
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Affiliation(s)
- Kevin P Fennelly
- National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, MD.
| | | | - Edward Jones-Lopez
- Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - William G Lindsley
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD
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Meisel JS, Nasko DJ, Brubach B, Cepeda-Espinoza V, Chopyk J, Corrada-Bravo H, Fedarko M, Ghurye J, Javkar K, Olson ND, Shah N, Allard SM, Bazinet AL, Bergman NH, Brown A, Caporaso JG, Conlan S, DiRuggiero J, Forry SP, Hasan NA, Kralj J, Luethy PM, Milton DK, Ondov BD, Preheim S, Ratnayake S, Rogers SM, Rosovitz MJ, Sakowski EG, Schliebs NO, Sommer DD, Ternus KL, Uritskiy G, Zhang SX, Pop M, Treangen TJ. Current progress and future opportunities in applications of bioinformatics for biodefense and pathogen detection: report from the Winter Mid-Atlantic Microbiome Meet-up, College Park, MD, January 10, 2018. Microbiome 2018; 6:197. [PMID: 30396371 PMCID: PMC6219074 DOI: 10.1186/s40168-018-0582-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/18/2018] [Indexed: 06/08/2023]
Abstract
The Mid-Atlantic Microbiome Meet-up (M3) organization brings together academic, government, and industry groups to share ideas and develop best practices for microbiome research. In January of 2018, M3 held its fourth meeting, which focused on recent advances in biodefense, specifically those relating to infectious disease, and the use of metagenomic methods for pathogen detection. Presentations highlighted the utility of next-generation sequencing technologies for identifying and tracking microbial community members across space and time. However, they also stressed the current limitations of genomic approaches for biodefense, including insufficient sensitivity to detect low-abundance pathogens and the inability to quantify viable organisms. Participants discussed ways in which the community can improve software usability and shared new computational tools for metagenomic processing, assembly, annotation, and visualization. Looking to the future, they identified the need for better bioinformatics toolkits for longitudinal analyses, improved sample processing approaches for characterizing viruses and fungi, and more consistent maintenance of database resources. Finally, they addressed the necessity of improving data standards to incentivize data sharing. Here, we summarize the presentations and discussions from the meeting, identifying the areas where microbiome analyses have improved our ability to detect and manage biological threats and infectious disease, as well as gaps of knowledge in the field that require future funding and focus.
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Affiliation(s)
- Jacquelyn S Meisel
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Daniel J Nasko
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Brian Brubach
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Victoria Cepeda-Espinoza
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Jessica Chopyk
- School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | - Héctor Corrada-Bravo
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Marcus Fedarko
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Jay Ghurye
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Kiran Javkar
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Nathan D Olson
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Nidhi Shah
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Sarah M Allard
- School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | - Adam L Bazinet
- National Biodefense Analysis and Countermeasures Center, Frederick, MD, USA
| | - Nicholas H Bergman
- National Biodefense Analysis and Countermeasures Center, Frederick, MD, USA
| | - Alexis Brown
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - J Gregory Caporaso
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Sean Conlan
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Samuel P Forry
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Nur A Hasan
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
- CosmosID, Inc., Rockville, MD, USA
| | - Jason Kralj
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Paul M Luethy
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | - Brian D Ondov
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sarah Preheim
- Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - M J Rosovitz
- National Biodefense Analysis and Countermeasures Center, Frederick, MD, USA
| | - Eric G Sakowski
- Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Daniel D Sommer
- National Biodefense Analysis and Countermeasures Center, Frederick, MD, USA
| | | | - Gherman Uritskiy
- Department of Biology, Johns Hopkins University, Baltimore, MD, USA
| | - Sean X Zhang
- Division of Medical Microbiology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mihai Pop
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Todd J Treangen
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA.
- Present address: Department of Computer Science - MS-132, Rice University, P.O. Box 1892, Houston, TX, 77005-1892, USA.
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Chen S, Kang J, Xing Y, Zhao Y, Milton DK. Estimating large covariance matrix with network topology for high-dimensional biomedical data. Comput Stat Data Anal 2018. [DOI: 10.1016/j.csda.2018.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yan J, Grantham M, Pantelic J, Bueno de Mesquita PJ, Albert B, Liu F, Ehrman S, Milton DK. Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community. Proc Natl Acad Sci U S A 2018; 115:1081-1086. [PMID: 29348203 PMCID: PMC5798362 DOI: 10.1073/pnas.1716561115] [Citation(s) in RCA: 331] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Little is known about the amount and infectiousness of influenza virus shed into exhaled breath. This contributes to uncertainty about the importance of airborne influenza transmission. We screened 355 symptomatic volunteers with acute respiratory illness and report 142 cases with confirmed influenza infection who provided 218 paired nasopharyngeal (NP) and 30-minute breath samples (coarse >5-µm and fine ≤5-µm fractions) on days 1-3 after symptom onset. We assessed viral RNA copy number for all samples and cultured NP swabs and fine aerosols. We recovered infectious virus from 52 (39%) of the fine aerosols and 150 (89%) of the NP swabs with valid cultures. The geometric mean RNA copy numbers were 3.8 × 104/30-minutes fine-, 1.2 × 104/30-minutes coarse-aerosol sample, and 8.2 × 108 per NP swab. Fine- and coarse-aerosol viral RNA were positively associated with body mass index and number of coughs and negatively associated with increasing days since symptom onset in adjusted models. Fine-aerosol viral RNA was also positively associated with having influenza vaccination for both the current and prior season. NP swab viral RNA was positively associated with upper respiratory symptoms and negatively associated with age but was not significantly associated with fine- or coarse-aerosol viral RNA or their predictors. Sneezing was rare, and sneezing and coughing were not necessary for infectious aerosol generation. Our observations suggest that influenza infection in the upper and lower airways are compartmentalized and independent.
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Affiliation(s)
- Jing Yan
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742
- Department of Chemical and Biomolecular Engineering, Clark School of Engineering, University of Maryland, College Park, MD 20742
| | - Michael Grantham
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742
| | - Jovan Pantelic
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742
| | - P Jacob Bueno de Mesquita
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742
| | - Barbara Albert
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742
| | - Fengjie Liu
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742
| | - Sheryl Ehrman
- Department of Chemical and Biomolecular Engineering, Clark School of Engineering, University of Maryland, College Park, MD 20742
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742;
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Sangaramoorthy T, Jamison AM, Boyle MD, Payne-Sturges DC, Sapkota A, Milton DK, Wilson SM. Place-based perceptions of the impacts of fracking along the Marcellus Shale. Soc Sci Med 2016; 151:27-37. [PMID: 26773295 DOI: 10.1016/j.socscimed.2016.01.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/22/2015] [Accepted: 01/03/2016] [Indexed: 11/29/2022]
Abstract
We examined community perspectives and experiences with fracking in Doddridge County, West Virginia, USA as part of a larger assessment to investigate the potential health impacts associated with fracking in neighboring Maryland, USA. In November 2013, we held two focus groups with community residents who had been impacted by fracking operations and conducted field observations in the impacted areas. Employing grounded theory, we conducted qualitative analysis to explore emergent themes related to direct and indirect health impacts of fracking. Three components of experience were identified, including (a) meanings of place and identity, (b) transforming relationships, and (c) perceptions of environmental and health impacts. Our findings indicate that fracking contributes to a disruption in residents' sense of place and social identity, generating widespread social stress. Although community residents acknowledged the potential for economic growth brought about by fracking, rapid transformations in meanings of place and social identity influenced residents' perceptions of environmental and health impacts. Our findings suggest that in order to have a more complete understanding of the health impacts of fracking, future work must consider the complex linkages between social disruption, environmental impacts, and health outcomes through critical engagements with communities undergoing energy development.
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Affiliation(s)
- Thurka Sangaramoorthy
- Department of Anthropology, University of Maryland, 1111 Woods Hall, 4302 Chapel Lane, College Park, MD, 20742, USA.
| | - Amelia M Jamison
- Department of Epidemiology and Biostatistics, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
| | - Meleah D Boyle
- Maryland Institute for Applied Environmental Health, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
| | - Devon C Payne-Sturges
- Maryland Institute for Applied Environmental Health, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
| | - Amir Sapkota
- Maryland Institute for Applied Environmental Health, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
| | - Sacoby M Wilson
- Maryland Institute for Applied Environmental Health, University of Maryland, 255 Valley Drive, College Park, MD, 20742, USA
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Boyle MD, Payne-Sturges DC, Sangaramoorthy T, Wilson S, Nachman KE, Babik K, Jenkins CC, Trowell J, Milton DK, Sapkota A. Hazard Ranking Methodology for Assessing Health Impacts of Unconventional Natural Gas Development and Production: The Maryland Case Study. PLoS One 2016; 11:e0145368. [PMID: 26726918 PMCID: PMC4700999 DOI: 10.1371/journal.pone.0145368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/01/2015] [Indexed: 11/18/2022] Open
Abstract
The recent growth of unconventional natural gas development and production (UNGDP) has outpaced research on the potential health impacts associated with the process. The Maryland Marcellus Shale Public Health Study was conducted to inform the Maryland Marcellus Shale Safe Drilling Initiative Advisory Commission, State legislators and the Governor about potential public health impacts associated with UNGDP so they could make an informed decision that considers the health and well-being of Marylanders. In this paper, we describe an impact assessment and hazard ranking methodology we used to assess the potential public health impacts for eight hazards associated with the UNGDP process. The hazard ranking included seven metrics: 1) presence of vulnerable populations (e.g. children under the age of 5, individuals over the age of 65, surface owners), 2) duration of exposure, 3) frequency of exposure, 4) likelihood of health effects, 5) magnitude/severity of health effects, 6) geographic extent, and 7) effectiveness of setbacks. Overall public health concern was determined by a color-coded ranking system (low, moderately high, and high) that was generated based on the overall sum of the scores for each hazard. We provide three illustrative examples of applying our methodology for air quality and health care infrastructure which were ranked as high concern and for water quality which was ranked moderately high concern. The hazard ranking was a valuable tool that allowed us to systematically evaluate each of the hazards and provide recommendations to minimize the hazards.
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Affiliation(s)
- Meleah D. Boyle
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Devon C. Payne-Sturges
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Thurka Sangaramoorthy
- Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland, College Park, Maryland, United States of America
| | - Sacoby Wilson
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Keeve E. Nachman
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kelsey Babik
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Christian C. Jenkins
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Joshua Trowell
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Donald K. Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Amir Sapkota
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
- * E-mail:
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Lamnisos D, Moustaki M, Kolokotroni O, Koksoy H, Faiz M, Arifoglu K, Milton DK, Middleton N, Yiallouros PK. Prevalence of asthma and allergies in children from the Greek-Cypriot and Turkish-Cypriot communities in Cyprus: a bi-communal cross-sectional study. BMC Public Health 2013; 13:585. [PMID: 23767800 PMCID: PMC3698153 DOI: 10.1186/1471-2458-13-585] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 05/28/2013] [Indexed: 12/17/2022] Open
Abstract
Background The Greek-Cypriot (G/C) and Turkish-Cypriot (T/C) communities have lived apart since 1974, with the former presumably adopting a more westernized way of life. We estimated the prevalence of asthma and allergies among children in the two communities and investigated differences in socio-demographic and lifestyle risk factors. Methods The ISAAC questionnaire was completed by 10156 children aged 7–8 and 13–14 years. Relative differences in asthma and allergic symptoms between the two communities were expressed as odds ratios (OR), estimated in multivariable logistic regression models before and after adjusting for participants’ risk characteristics. Results In contrast to our original speculation, consistently lower prevalence rates were observed for respiratory outcomes (but not eczema) among G/C compared to T/C children in both age-groups. For instance, the prevalence of current wheeze among 7–8 year-olds was 8.7% vs 11.4% (OR = 0.74, 95%, CI: 0.61, 0.90) and of current rhinoconjuctivitis 2.6% vs 4.9% (OR = 0.52, 95% CI: 0.37, 0.71). Surprisingly, the proportion reporting family history of allergy was almost double in the G/C community. With the exception of early life nursery attendance, several protective factors were more prevalent amongst T/C, such as bedroom sharing, less urbanized environment and exposure to farm animals. In contrast, exposure to tobacco smoke was more frequent in the T/C community. Controlling for risk factors did not account for the observed lower prevalence of current wheeze (in the younger age-group) and rhinoconjuctivitis (in both age-groups) among G/C children while differences in the prevalence of eczema between the two communities were no longer statistically significant. Conclusions A mixed picture of potential risk factors was observed in the two communities of Cyprus, not consistently favoring one over the other community since, for example, bedroom sharing and rural living but also exposure to tobacco smoke were more common among T/C children. Investigated risk factors do not fully account for the lower prevalence of asthma and allergies among G/C children, especially against a background of higher family history of allergy in this community.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Panayiotis K Yiallouros
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus.
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Milton DK, Fabian MP, Cowling BJ, Grantham ML, McDevitt JJ. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS Pathog 2013; 9:e1003205. [PMID: 23505369 PMCID: PMC3591312 DOI: 10.1371/journal.ppat.1003205] [Citation(s) in RCA: 426] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/09/2013] [Indexed: 12/11/2022] Open
Abstract
The CDC recommends that healthcare settings provide influenza patients with facemasks as a means of reducing transmission to staff and other patients, and a recent report suggested that surgical masks can capture influenza virus in large droplet spray. However, there is minimal data on influenza virus aerosol shedding, the infectiousness of exhaled aerosols, and none on the impact of facemasks on viral aerosol shedding from patients with seasonal influenza. We collected samples of exhaled particles (one with and one without a facemask) in two size fractions (“coarse”>5 µm, “fine”≤5 µm) from 37 volunteers within 5 days of seasonal influenza onset, measured viral copy number using quantitative RT-PCR, and tested the fine-particle fraction for culturable virus. Fine particles contained 8.8 (95% CI 4.1 to 19) fold more viral copies than did coarse particles. Surgical masks reduced viral copy numbers in the fine fraction by 2.8 fold (95% CI 1.5 to 5.2) and in the coarse fraction by 25 fold (95% CI 3.5 to 180). Overall, masks produced a 3.4 fold (95% CI 1.8 to 6.3) reduction in viral aerosol shedding. Correlations between nasopharyngeal swab and the aerosol fraction copy numbers were weak (r = 0.17, coarse; r = 0.29, fine fraction). Copy numbers in exhaled breath declined rapidly with day after onset of illness. Two subjects with the highest copy numbers gave culture positive fine particle samples. Surgical masks worn by patients reduce aerosols shedding of virus. The abundance of viral copies in fine particle aerosols and evidence for their infectiousness suggests an important role in seasonal influenza transmission. Monitoring exhaled virus aerosols will be important for validation of experimental transmission studies in humans. The relative importance of direct and indirect contact, large droplet spray, and aerosols as modes of influenza transmission is not known but is important in devising effective interventions. Surgical facemasks worn by patients are recommended by the CDC as a means of reducing the spread of influenza in healthcare facilities. We sought to determine the total number of viral RNA copies present in exhaled breath and cough aerosols, whether the RNA copies in fine particle aerosols represent infectious virus, and whether surgical facemasks reduce the amount of virus shed into aerosols by people infected with seasonal influenza viruses. We found that total viral copies detected by molecular methods were 8.8 times more numerous in fine (≤5 µm) than in coarse (>5 µm) aerosol particles and that the fine particles from cases with the highest total number of viral RNA copies contained infectious virus. Surgical masks reduced the overall number of RNA copies by 3.4 fold. These results suggest an important role for aerosols in transmission of influenza virus and that surgical facemasks worn by infected persons are potentially an effective means of limiting the spread of influenza.
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Affiliation(s)
- Donald K Milton
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, United States of America.
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Bello A, Quinn MM, Milton DK, Perry MJ. Determinants of exposure to 2-butoxyethanol from cleaning tasks: a quasi-experimental study. Ann Occup Hyg 2013; 57:125-35. [PMID: 22997411 DOI: 10.1093/annhyg/mes054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The quantitative assessment of airborne cleaning exposures requires numerous measurement methods, which are costly and difficult to apply in the workplace. Exposure determinants can be used to predict exposures but have yet to be investigated for cleaning activities. We identified determinants of exposure to 2-butoxyethanol (2-BE), a known respiratory irritant and suspected human carcinogen, commonly found in cleaning products. In addition, we investigated whether 2-BE exposures can be predicted from exposure determinants and total volatile organic compounds (TVOCs) measured with direct reading methods, which are easier to apply in field investigations. METHODS Exposure determinants were studied in a quasi-experimental study design. Cleaning tasks were performed similarly as in the workplace, but potential factors that can impact exposures were controlled. Simultaneously for each task, we measured concentrations of (1) 2-BE according to the National Institute for Occupational Health and Safety 1430 method and (2) TVOC with photoionization detectors (PIDs). Simple and multiple linear regression analyses were performed to identify 2-BE exposure determinants and to develop exposure prediction models. RESULTS Significant determinants from univariate analyses consisted of product type, tasks performed, room volume, and ventilation. The best-fit multivariable model was the one comprised of product type, tasks performed, 2-BE product concentration, room volume, and ventilation (R(2) = 77%). We found a strong correlation between the 2-BE and the TVOC concentrations recorded by the PID instruments. A multivariable model with TVOC explained a significant portion of the 2-BE concentrations (R(2) = 72%) when product type and room ventilation were included in the model. CONCLUSIONS Our results suggest that quantitative exposure assessment for an epidemiologic investigation of cleaning health effects may be feasible even without performing integrated sampling and analytic measurements.
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Affiliation(s)
- Anila Bello
- Department of Work Environment, University of Massachusetts Lowell, One University Avenue, Lowell, MA 01854, USA.
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McDevitt JJ, Koutrakis P, Ferguson ST, Wolfson JM, Fabian MP, Martins M, Pantelic J, Milton DK. Development and Performance Evaluation of an Exhaled-Breath Bioaerosol Collector for Influenza Virus. Aerosol Sci Technol 2013; 47:444-451. [PMID: 23418400 PMCID: PMC3570155 DOI: 10.1080/02786826.2012.762973] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The importance of the aerosol mode for transmission of influenza is unknown. Understanding the role of aerosols is essential to developing public health interventions such as the use of surgical masks as a source control to prevent the release of infectious aerosols. Little information is available on the number and size of particles generated by infected persons, which is partly due to the limitations of conventional air samplers, which do not efficiently capture fine particles or maintain microorganism viability. We designed and built a new sampler, called the G-II, that collects exhaled breath particles that can be used in infectivity analyses. The G-II allows test subjects to perform various respiratory maneuvers (i.e. tidal breathing, coughing, and talking) and allows subjects to wear a mask or respirator during testing. A conventional slit impactor collects particles > 5.0 μm. Condensation of water vapor is used to grow remaining particles, including fine particles, to a size large enough to be efficiently collected by a 1.0 μm slit impactor and be deposited into a buffer-containing collector. We evaluated the G-II for fine particle collection efficiency with inert particle aerosols and evaluated infective virus collection using influenza A virus aerosols. Testing results showed greater than 85% collection efficiency for particles greater than 50nm and influenza virus collection comparable with a reference SKC BioSampler®. The new design will enable determination of exhaled infectious virus generation rate and evaluate control strategies such as wearing a surgical type mask to prevent the release of viruses from infected persons.
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Abstract
The mode of infection transmission has profound implications for effective containment by public health interventions. The mode of smallpox transmission was never conclusively established. Although, "respiratory droplet" transmission was generally regarded as the primary mode of transmission, the relative importance of large ballistic droplets and fine particle aerosols that remain suspended in air for more than a few seconds was never resolved. This review examines evidence from the history of variolation, data on mucosal infection collected in the last decades of smallpox transmission, aerosol measurements, animal models, reports of smallpox lung among healthcare workers, and the epidemiology of smallpox regarding the potential importance of fine particle aerosol mediated transmission. I introduce briefly the term anisotropic infection to describe the behavior of Variola major in which route of infection appears to have altered the severity of disease.
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Affiliation(s)
- Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland College Park, MD, USA; Department of Medicine, University of Maryland School of Medicine Baltimore, MD, USA; Department of Environmental Health, Harvard School of Public Health Boston, MA, USA.
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Yiallouros PK, Savva SC, Kolokotroni O, Behbod B, Zeniou M, Economou M, Chadjigeorgiou C, Kourides YA, Tornaritis MJ, Lamnisos D, Middleton N, Milton DK. Low serum high-density lipoprotein cholesterol in childhood is associated with adolescent asthma. Clin Exp Allergy 2012; 42:423-32. [PMID: 22356143 DOI: 10.1111/j.1365-2222.2011.03940.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Whilst emerging evidence from animal and cell experiments has shown high-density lipoprotein cholesterol to have anti-inflammatory effects consistent with a protective role in asthma, human studies investigating the relationship of high-density lipoprotein cholesterol with asthma have produced conflicting results. OBJECTIVE To examine the association between serum lipids among Cypriot children aged 11-12 years and prevalence of asthma at age 15-17 years. METHODS In 3982 children, we assessed serum lipids, body mass index and maximal oxygen consumption at baseline (2001-2003) and explored associations with respiratory health at follow-up (2007) using multiple logistic regression models. RESULTS Lower levels of high-density lipoprotein cholesterol at age 11-12 years were found in subjects who reported ever asthma (58.2 vs. 60.0 mg/dL, P = 0.005) and active asthma (57.5 vs. 59.9 mg/dL, P = 0.010) in adolescence, in comparison with their respective reference groups. Total cholesterol, low-density lipoprotein and triglycerides had no association with any of the asthma outcomes. In contrast, with estimated odds ratios of 1.89 (95% CI 1.19-3.00) and 1.89 (95% CI 1.02-3.53), ever asthma and active asthma respectively appeared particularly pronounced among those who at baseline had high-density lipoprotein cholesterol <40 mg/dL, even after adjusting for potential confounders including body mass index and maximal oxygen consumption. CONCLUSIONS & CLINICAL RELEVANCE Low-serum high-density lipoprotein cholesterol in childhood is associated with an increased risk for asthma in adolescence, suggesting a potential role of this lipoprotein in the pathogenesis of paediatric asthma.
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Affiliation(s)
- P K Yiallouros
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus.
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Sharma S, Poon A, Himes BE, Lasky-Su J, Sordillo JE, Belanger K, Milton DK, Bracken MB, Triche EW, Leaderer BP, Gold DR, Litonjua AA. Association of variants in innate immune genes with asthma and eczema. Pediatr Allergy Immunol 2012; 23:315-23. [PMID: 22192168 PMCID: PMC3412627 DOI: 10.1111/j.1399-3038.2011.01243.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The innate immune pathway is important in the pathogenesis of asthma and eczema. However, only a few variants in these genes have been associated with either disease. We investigate the association between polymorphisms of genes in the innate immune pathway with childhood asthma and eczema. In addition, we compare individual associations with those discovered using a multivariate approach. METHODS Using a novel method, case control based association testing (C2BAT), 569 single nucleotide polymorphisms (SNPs) in 44 innate immune genes were tested for association with asthma and eczema in children from the Boston Home Allergens and Asthma Study and the Connecticut Childhood Asthma Study. The screening algorithm was used to identify the top SNPs associated with asthma and eczema. We next investigated the interaction of innate immune variants with asthma and eczema risk using Bayesian networks. RESULTS After correction for multiple comparisons, 7 SNPs in 6 genes (CARD25, TGFB1, LY96, ACAA1, DEFB1, and IFNG) were associated with asthma (adjusted p-value<0.02), while 5 SNPs in 3 different genes (CD80, STAT4, and IRAKI) were significantly associated with eczema (adjusted p-value < 0.02). None of these SNPs were associated with both asthma and eczema. Bayesian network analysis identified 4 SNPs that were predictive of asthma and 10 SNPs that predicted eczema. Of the genes identified using Bayesian networks, only CD80 was associated with eczema in the single-SNP study. Using novel methodology that allows for screening and replication in the same population, we have identified associations of innate immune genes with asthma and eczema. Bayesian network analysis suggests that additional SNPs influence disease susceptibility via SNP interactions. CONCLUSION Our findings suggest that innate immune genes contribute to the pathogenesis of asthma and eczema, and that these diseases likely have different genetic determinants.
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Affiliation(s)
- Sunita Sharma
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Abstract
BACKGROUND Collection of exhaled breath samples for the analysis of inflammatory biomarkers is an important area of research aimed at improving our ability to diagnose, treat and understand the mechanisms of chronic pulmonary disease. Current collection methods based on condensation of water vapor from exhaled breath yield biomarker levels at or near the detection limits of immunoassays contributing to problems with reproducibility and validity of biomarker measurements. In this study, we compare the collection efficiency of two aerosol-to-liquid sampling devices to a filter-based collection method for recovery of dilute laboratory generated aerosols of human cytokines so as to identify potential alternatives to exhaled breath condensate collection. METHODOLOGY/PRINCIPAL FINDINGS Two aerosol-to-liquid sampling devices, the SKC® Biosampler and Omni 3000™, as well as Teflon® filters were used to collect aerosols of human cytokines generated using a HEART nebulizer and single-pass aerosol chamber setup in order to compare the collection efficiencies of these sampling methods. Additionally, methods for the use of Teflon® filters to collect and measure cytokines recovered from aerosols were developed and evaluated through use of a high-sensitivity multiplex immunoassay. Our results show successful collection of cytokines from pg/m(3) aerosol concentrations using Teflon® filters and measurement of cytokine levels in the sub-picogram/mL concentration range using a multiplex immunoassay with sampling times less than 30 minutes. Significant degradation of cytokines was observed due to storage of cytokines in concentrated filter extract solutions as compared to storage of dry filters. CONCLUSIONS Use of filter collection methods resulted in significantly higher efficiency of collection than the two aerosol-to-liquid samplers evaluated in our study. The results of this study provide the foundation for a potential new technique to evaluate biomarkers of inflammation in exhaled breath samples.
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Affiliation(s)
- Jennifer H. McKenzie
- Biomedical Engineering and Biotechnology Program, University of Massachusetts, Lowell, Massachusetts, United States of America
| | - James J. McDevitt
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - M. Patricia Fabian
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Grace M. Hwang
- The MITRE Corporation, McLean, Virginia, United States of America
| | - Donald K. Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
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