1
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Anderer S. CDC Eases Isolation Guidance for Respiratory Viruses. JAMA 2024; 331:1081. [PMID: 38477941 DOI: 10.1001/jama.2024.2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
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2
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Endo (遠藤彰) A, Uchida (内田満夫) M, Liu (刘扬) Y, Atkins KE, Kucharski AJ, Funk S. Simulating respiratory disease transmission within and between classrooms to assess pandemic management strategies at schools. Proc Natl Acad Sci U S A 2022; 119:e2203019119. [PMID: 36074818 PMCID: PMC9478679 DOI: 10.1073/pnas.2203019119] [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: 02/28/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022] Open
Abstract
The global spread of coronavirus disease 2019 (COVID-19) has emphasized the need for evidence-based strategies for the safe operation of schools during pandemics that balance infection risk with the society's responsibility of allowing children to attend school. Due to limited empirical data, existing analyses assessing school-based interventions in pandemic situations often impose strong assumptions, for example, on the relationship between class size and transmission risk, which could bias the estimated effect of interventions, such as split classes and staggered attendance. To fill this gap in school outbreak studies, we parameterized an individual-based model that accounts for heterogeneous contact rates within and between classes and grades to a multischool outbreak data of influenza. We then simulated school outbreaks of respiratory infectious diseases of ongoing threat (i.e., COVID-19) and potential threat (i.e., pandemic influenza) under a variety of interventions (changing class structures, symptom screening, regular testing, cohorting, and responsive class closures). Our results suggest that interventions changing class structures (e.g., reduced class sizes) may not be effective in reducing the risk of major school outbreaks upon introduction of a case and that other precautionary measures (e.g., screening and isolation) need to be employed. Class-level closures in response to detection of a case were also suggested to be effective in reducing the size of an outbreak.
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Affiliation(s)
- Akira Endo (遠藤彰)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Alan Turing Institute, London NW1 2DB, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan
- Japan Society for the Promotion of Science, Tokyo 102-0083, Japan
| | - CMMID COVID-19 Working Group
- The Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | | | - Yang Liu (刘扬)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Katherine E. Atkins
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh EH16 4UX, United Kingdom
| | - Adam J. Kucharski
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Sebastian Funk
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
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3
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Li Y, Cheng P, Jia W. Poor ventilation worsens short-range airborne transmission of respiratory infection. Indoor Air 2022; 32:e12946. [PMID: 34704625 PMCID: PMC8652937 DOI: 10.1111/ina.12946] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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: 12/26/2020] [Revised: 08/31/2021] [Accepted: 10/12/2021] [Indexed: 05/20/2023]
Abstract
To explain the observed phenomenon that most SARS-CoV-2 transmission occurs indoors whereas its outdoor transmission is rare, a simple macroscopic aerosol balance model is developed to link short- and long-range airborne transmission. The model considers the involvement of exhaled droplets with initial diameter ≤50 µm in the short-range airborne route, whereas only a fraction of these droplets with an initial diameter within 15 µm or equivalently a final diameter within 5 µm considered in the long-range airborne route. One surprising finding is that the room ventilation rate significantly affects the short-range airborne route, in contrast to traditional belief. When the ventilation rate in a room is insufficient, the airborne infection risks due to both short- and long-range transmission are high. A ventilation rate of 10 L/s per person provides a similar concentration vs distance decay profile to that in outdoor settings, which provides additional justification for the widely adopted ventilation standard of 10 L/s per person. The newly obtained data do not support the basic assumption in the existing ventilation standard ASHRAE 62.1 (2019) that the required people outdoor air rate is constant if the standard is used directly for respiratory infection control. Instead, it is necessary to increase the ventilation rate when the physical distance between people is less than approximately 2 m.
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Affiliation(s)
- Yuguo Li
- Department of Mechanical EngineeringThe University of Hong KongHong Kong SARChina
| | - Pan Cheng
- Department of Mechanical EngineeringThe University of Hong KongHong Kong SARChina
| | - Wei Jia
- Department of Mechanical EngineeringThe University of Hong KongHong Kong SARChina
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4
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Huang Y, Chattopadhyay I. Universal risk phenotype of US counties for flu-like transmission to improve county-specific COVID-19 incidence forecasts. PLoS Comput Biol 2021; 17:e1009363. [PMID: 34648492 PMCID: PMC8516313 DOI: 10.1371/journal.pcbi.1009363] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/18/2021] [Indexed: 12/23/2022] Open
Abstract
The spread of a communicable disease is a complex spatio-temporal process shaped by the specific transmission mechanism, and diverse factors including the behavior, socio-economic and demographic properties of the host population. While the key factors shaping transmission of influenza and COVID-19 are beginning to be broadly understood, making precise forecasts on case count and mortality is still difficult. In this study we introduce the concept of a universal geospatial risk phenotype of individual US counties facilitating flu-like transmission mechanisms. We call this the Universal Influenza-like Transmission (UnIT) score, which is computed as an information-theoretic divergence of the local incidence time series from an high-risk process of epidemic initiation, inferred from almost a decade of flu season incidence data gleaned from the diagnostic history of nearly a third of the US population. Despite being computed from the past seasonal flu incidence records, the UnIT score emerges as the dominant factor explaining incidence trends for the COVID-19 pandemic over putative demographic and socio-economic factors. The predictive ability of the UnIT score is further demonstrated via county-specific weekly case count forecasts which consistently outperform the state of the art models throughout the time-line of the COVID-19 pandemic. This study demonstrates that knowledge of past epidemics may be used to chart the course of future ones, if transmission mechanisms are broadly similar, despite distinct disease processes and causative pathogens. Accurate case count forecasts in an epidemic is non-trivial, with the spread of infectious diseases being modulated by diverse hard-to-model factors. This study introduces the concept of a universal risk phenotype for US counties that predictably increases the risk of person-to-person transmission of influenza-like illnesses; universal in the sense that it is pathogen-agnostic provided the transmission mechanism is similar to that of seasonal influenza. We call this the Universal Influenza-like Transmission (UnIT) score, which accounts for unmodeled effects by automatically leveraging subtle geospatial patterns underlying the flu epidemics of the past. It is a phenotype of the counties themselves, as it characterizes how the transmission process is differentially impacted in different geospatial contexts. Grounded in information-theory and machine learning, the UnIT score reduces the need to manually identify every factor that impacts the case counts. Applying to the COVID-19 pandemic, we show that incidence patterns from a past epidemic caused by an appropriately-chosen distinct pathogen can substantially inform future projections. Our forecasts consistently outperform the state of the art models throughout the time-line of the COVID-19 pandemic, and thus is an important step to inform policy decisions in current and future pandemics.
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Affiliation(s)
- Yi Huang
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Ishanu Chattopadhyay
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
- Committee on Genetics, Genomics & Systems Biology, University of Chicago, Chicago, Illinois, United States of America
- Committee on Quantitative Methods in Social, Behavioral, and Health Sciences, University of Chicago, Chicago, Illinois, United States of America
- Center of Health Statistics, University of Chicago, Chicago, Illinois, United States of America
- * E-mail:
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5
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Morrison RE, Mushimiyimana Y, Stoinski TS, Eckardt W. Rapid transmission of respiratory infections within but not between mountain gorilla groups. Sci Rep 2021; 11:19622. [PMID: 34620899 PMCID: PMC8497490 DOI: 10.1038/s41598-021-98969-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/09/2021] [Indexed: 02/06/2023] Open
Abstract
Minimizing disease transmission between humans and wild apes and controlling outbreaks in ape populations is vital to both ape conservation and human health, but information on the transmission of real infections in wild populations is rare. We analyzed respiratory outbreaks in a subpopulation of wild mountain gorillas (Gorilla beringei beringei) between 2004 and 2020. We investigated transmission within groups during 7 outbreaks using social networks based on contact and proximity, and transmission between groups during 15 outbreaks using inter-group encounters, transfers and home range overlap. Patterns of contact and proximity within groups were highly predictable based on gorillas' age and sex. Disease transmission within groups was rapid with a median estimated basic reproductive number (R0) of 4.18 (min = 1.74, max = 9.42), and transmission was not predicted by the social network. Between groups, encounters and transfers did not appear to have enabled disease transmission and the overlap of groups' ranges did not predict concurrent outbreaks. Our findings suggest that gorilla social structure, with many strong connections within groups and weak ties between groups, may enable rapid transmission within a group once an infection is present, but limit the transmission of infections between groups.
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Affiliation(s)
- Robin E Morrison
- Dian Fossey Gorilla Fund, Musanze, Rwanda.
- Centre for Research in Animal Behavior, University of Exeter, Exeter, UK.
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6
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Liu PY, Gragnani CM, Timmerman J, Newhouse CN, Soto G, Lopez L, Spronz R, Mhaskar A, Yeganeh N, Fernandes P, Kuo AA. Pediatric Household Transmission of Severe Acute Respiratory Coronavirus-2 Infection-Los Angeles County, December 2020 to February 2021. Pediatr Infect Dis J 2021; 40:e379-e381. [PMID: 34387617 PMCID: PMC8443424 DOI: 10.1097/inf.0000000000003251] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/26/2022]
Abstract
This brief report presents transmission rates from a prospective study of 15 households with pediatric index cases of severe acute respiratory coronavirus-2 in Los Angeles County from December 2020 to February 2021. Our findings support ongoing evidence that transmission from pediatric index cases to household contacts is frequent but can be mitigated with practicing well-documented control measures at home, including isolation, masking and good hand hygiene.
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Affiliation(s)
| | | | - Jason Timmerman
- Department of Medicine, David Geffen School of Medicine at UCLA
| | | | - Gabriela Soto
- Department of Medicine, David Geffen School of Medicine at UCLA
| | - Lizzet Lopez
- Department of Medicine, David Geffen School of Medicine at UCLA
| | - Rachel Spronz
- Department of Medicine, David Geffen School of Medicine at UCLA
| | - Aditi Mhaskar
- Department of Medicine, David Geffen School of Medicine at UCLA
| | - Nava Yeganeh
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine at UCLA
| | | | - Alice A Kuo
- Department of Pediatrics, Division of Child Health Policy, David Geffen School of Medicine at UCLA, Los Angeles, California
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7
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Fiorino S, Tateo F, Biase DD, Gallo CG, Orlandi PE, Corazza I, Budriesi R, Micucci M, Visani M, Loggi E, Hong W, Pica R, Lari F, Zippi M. SARS-CoV-2: lessons from both the history of medicine and from the biological behavior of other well-known viruses. Future Microbiol 2021; 16:1105-1133. [PMID: 34468163 PMCID: PMC8412036 DOI: 10.2217/fmb-2021-0064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
SARS-CoV-2 is the etiological agent of the current pandemic worldwide and its associated disease COVID-19. In this review, we have analyzed SARS-CoV-2 characteristics and those ones of other well-known RNA viruses viz. HIV, HCV and Influenza viruses, collecting their historical data, clinical manifestations and pathogenetic mechanisms. The aim of the work is obtaining useful insights and lessons for a better understanding of SARS-CoV-2. These pathogens present a distinct mode of transmission, as SARS-CoV-2 and Influenza viruses are airborne, whereas HIV and HCV are bloodborne. However, these viruses exhibit some potential similar clinical manifestations and pathogenetic mechanisms and their understanding may contribute to establishing preventive measures and new therapies against SARS-CoV-2.
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Affiliation(s)
- Sirio Fiorino
- Internal Medicine Unit, Budrio Hospital, Budrio (Bologna), Azienda USL, Bologna, 40054, Italy
- Author for correspondence: Tel.: +39 051 809 259;
| | - Fabio Tateo
- Institute of Geosciences & Earth Resources, CNR, c/o Department of Geosciences, Padova University, 35127, Italy
| | - Dario De Biase
- Department of Pharmacy & Biotechnology, University of Bologna, Bologna, 40126, Italy
| | - Claudio G Gallo
- Fisiolaserterapico Emiliano, Castel San Pietro Terme, Bologna, 40024, Italy
| | | | - Ivan Corazza
- Department of Experimental, Diagnostic & Specialty Medicine, University of Bologna, Bologna, 40126, Italy
| | - Roberta Budriesi
- Department of Pharmacy & Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna, 40126, Italy
| | - Matteo Micucci
- Department of Pharmacy & Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna, 40126, Italy
| | - Michela Visani
- Department of Pharmacy & Biotechnology, University of Bologna, Bologna, 40126, Italy
| | - Elisabetta Loggi
- Hepatology Unit, Department of Medical & Surgical Sciences, University of Bologna, Bologna, 40126, Italy
| | - Wandong Hong
- Department of Gastroenterology & Hepatology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang, 325035, PR China
| | - Roberta Pica
- Unit of Gastroenterology & Digestive Endoscopy, Sandro Pertini Hospital, Rome, 00157, Italy
| | - Federico Lari
- Internal Medicine Unit, Budrio Hospital, Budrio (Bologna), Azienda USL, Bologna, 40054, Italy
| | - Maddalena Zippi
- Unit of Gastroenterology & Digestive Endoscopy, Sandro Pertini Hospital, Rome, 00157, Italy
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Abstract
The COVID-19 pandemic has revealed critical knowledge gaps in our understanding of and a need to update the traditional view of transmission pathways for respiratory viruses. The long-standing definitions of droplet and airborne transmission do not account for the mechanisms by which virus-laden respiratory droplets and aerosols travel through the air and lead to infection. In this Review, we discuss current evidence regarding the transmission of respiratory viruses by aerosols-how they are generated, transported, and deposited, as well as the factors affecting the relative contributions of droplet-spray deposition versus aerosol inhalation as modes of transmission. Improved understanding of aerosol transmission brought about by studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requires a reevaluation of the major transmission pathways for other respiratory viruses, which will allow better-informed controls to reduce airborne transmission.
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Affiliation(s)
- Chia C Wang
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China.
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA
- Aerosol Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
| | - Kimberly A Prather
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA.
| | - Josué Sznitman
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa 32000, Israel
| | - Jose L Jimenez
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa 32000, Israel
- Department of Chemistry and CIRES, University of Colorado, Boulder, CO 80309, USA
| | - Seema S Lakdawala
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Zeynep Tufekci
- School of Information and Department of Sociology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Linsey C Marr
- Aerosol Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
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9
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Abstract
The COVID-19 pandemic has revealed critical knowledge gaps in our understanding of and a need to update the traditional view of transmission pathways for respiratory viruses. The long-standing definitions of droplet and airborne transmission do not account for the mechanisms by which virus-laden respiratory droplets and aerosols travel through the air and lead to infection. In this Review, we discuss current evidence regarding the transmission of respiratory viruses by aerosols-how they are generated, transported, and deposited, as well as the factors affecting the relative contributions of droplet-spray deposition versus aerosol inhalation as modes of transmission. Improved understanding of aerosol transmission brought about by studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requires a reevaluation of the major transmission pathways for other respiratory viruses, which will allow better-informed controls to reduce airborne transmission.
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Affiliation(s)
- Chia C Wang
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China.
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA
- Aerosol Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
| | - Kimberly A Prather
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA.
| | - Josué Sznitman
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa 32000, Israel
| | - Jose L Jimenez
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa 32000, Israel
- Department of Chemistry and CIRES, University of Colorado, Boulder, CO 80309, USA
| | - Seema S Lakdawala
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Zeynep Tufekci
- School of Information and Department of Sociology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Linsey C Marr
- Aerosol Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
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10
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Feng L, Zhang T, Wang Q, Xie Y, Peng Z, Zheng J, Qin Y, Zhang M, Lai S, Wang D, Feng Z, Li Z, Gao GF. Impact of COVID-19 outbreaks and interventions on influenza in China and the United States. Nat Commun 2021; 12:3249. [PMID: 34059675 PMCID: PMC8167168 DOI: 10.1038/s41467-021-23440-1] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [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: 07/06/2020] [Accepted: 04/28/2021] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) was detected in China during the 2019-2020 seasonal influenza epidemic. Non-pharmaceutical interventions (NPIs) and behavioral changes to mitigate COVID-19 could have affected transmission dynamics of influenza and other respiratory diseases. By comparing 2019-2020 seasonal influenza activity through March 29, 2020 with the 2011-2019 seasons, we found that COVID-19 outbreaks and related NPIs may have reduced influenza in Southern and Northern China and the United States by 79.2% (lower and upper bounds: 48.8%-87.2%), 79.4% (44.9%-87.4%) and 67.2% (11.5%-80.5%). Decreases in influenza virus infection were also associated with the timing of NPIs. Without COVID-19 NPIs, influenza activity in China and the United States would likely have remained high during the 2019-2020 season. Our findings provide evidence that NPIs can partially mitigate seasonal and, potentially, pandemic influenza.
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Affiliation(s)
- Luzhao Feng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Ting Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Qing Wang
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yiran Xie
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention/Chinese National Influenza Center, Beijing, China
| | - Zhibin Peng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiandong Zheng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ying Qin
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Muli Zhang
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shengjie Lai
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Dayan Wang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention/Chinese National Influenza Center, Beijing, China
| | - Zijian Feng
- Office of Director, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhongjie Li
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - George F Gao
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention/Chinese National Influenza Center, Beijing, China.
- Office of Director, Chinese Center for Disease Control and Prevention, Beijing, China.
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11
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Nanda A, Hung I, Kwong A, Man VC, Roy P, Davies L, Douek M. Efficacy of surgical masks or cloth masks in the prevention of viral transmission: Systematic review, meta-analysis, and proposal for future trial. J Evid Based Med 2021; 14:97-111. [PMID: 33565274 PMCID: PMC8014575 DOI: 10.1111/jebm.12424] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/16/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Recommendations for widespread use of face mask, including suggested type, should reflect the current published evidence and concurrently be studied. This review evaluates the preclinical and clinical evidence on use of cloth and surgical face masks in SARS-CoV-2 transmission and proposes a trial to gather further evidence. METHODS PubMed, EMbase, and the Cochrane Library were searched. Studies of SARS-CoV-2 and face masks and randomized controlled trials (RCTs) of n ≥ 50 for other respiratory illnesses were included. RESULTS Fourteen studies were included in this study. One preclinical and 1 observational cohort clinical study found significant benefit of masks in limiting SARS-CoV-2 transmission. Eleven RCTs in a meta-analysis studying other respiratory illnesses found no significant benefit of masks (±hand hygiene) for influenza-like-illness symptoms nor laboratory confirmed viruses. One RCT found a significant benefit of surgical masks compared with cloth masks. CONCLUSION There is limited available preclinical and clinical evidence for face mask benefit in SARS-CoV-2. RCT evidence for other respiratory viral illnesses shows no significant benefit of masks in limiting transmission but is of poor quality and not SARS-CoV-2 specific. There is an urgent need for evidence from randomized controlled trials to investigate the efficacy of surgical and cloth masks on transmission of SARS-CoV-2 and user reported outcomes such as comfort and compliance.
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Affiliation(s)
- Akriti Nanda
- Oxford University Clinical Academic Graduate School, Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
| | - Ivan Hung
- Division of Infectious Diseases, Department of Medicine, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Ava Kwong
- Division of Breast Surgery, Department of Surgery, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Vivian Chi‐Mei Man
- Division of Breast Surgery, Department of Surgery, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Pankaj Roy
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
| | - Lucy Davies
- Surgical Interventional Trials Unit, Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Michael Douek
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
- Surgical Interventional Trials Unit, Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
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12
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O'Brien B, Goodridge L, Ronholm J, Nasheri N. Exploring the potential of foodborne transmission of respiratory viruses. Food Microbiol 2021; 95:103709. [PMID: 33397626 PMCID: PMC8035669 DOI: 10.1016/j.fm.2020.103709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023]
Abstract
The ongoing pandemic involving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised the question whether this virus, which is known to be spread primarily though respiratory droplets, could be spread through the fecal-oral route or via contaminated food. In this article, we present a critical review of the literature exploring the potential foodborne transmission of several respiratory viruses including human coronaviruses, avian influenza virus (AVI), parainfluenza viruses, human respiratory syncytial virus, adenoviruses, rhinoviruses, and Nipah virus. Multiple lines of evidence, including documented expression of receptor proteins on gastrointestinal epithelial cells, in vivo viral replication in gastrointestinal epithelial cell lines, extended fecal shedding of respiratory viruses, and the ability to remain infectious in food environments for extended periods of time raises the theoretical ability of some human respiratory viruses, particularly human coronaviruses and AVI, to spread via food. However, to date, neither epidemiological data nor case reports of clear foodborne transmission of either viruses exist. Thus, foodborne transmission of human respiratory viruses remains only a theoretical possibility.
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Affiliation(s)
- Bridget O'Brien
- Faculty of Agricultural and Environmental Sciences, Macdonald Campus, McGill University, Ste Anne de Bellevue, Québec, Canada
| | | | - Jennifer Ronholm
- Faculty of Agricultural and Environmental Sciences, Macdonald Campus, McGill University, Ste Anne de Bellevue, Québec, Canada
| | - Neda Nasheri
- Food Virology Laboratory, Bureau of Microbial Hazards, Health Canada, Ottawa, Ontario, Canada; Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, ON, Canada.
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13
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Chaabna K, Doraiswamy S, Mamtani R, Cheema S. Facemask use in community settings to prevent respiratory infection transmission: A rapid review and meta-analysis. Int J Infect Dis 2021; 104:198-206. [PMID: 32987183 PMCID: PMC7518963 DOI: 10.1016/j.ijid.2020.09.1434] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Synthesis of the available evidence on the effectiveness of medical and cloth facemask use by the general public in community settings is required to learn lessons for future respiratory epidemics/pandemics. METHOD Search terms relating to facemasks, infection and community settings were used for PubMed, the Cochrane Library Database and Google Scholar. A meta-analysis was conducted using a random-effects model. RESULTS The review included 12 primary studies on the effectiveness of medical facemask use to prevent influenza, influenza-like illness, SARS-CoV, and SARS-CoV-2 transmission. The meta-analysis demonstrated that facemask use significantly reduces the risk of transmitting these respiratory infections (pooled OR = 0.66, 95% CI 0.54-0.81). Of the 12 studies, 10 clinical trials suggested that respiratory infection incidence is lower with high medical facemask compliance, early use and use in combination with intensive hand hygiene. One cohort study conducted during the SARS-CoV-2 pandemic demonstrated that facemasks are effective in reducing SARS-CoV-2 transmission when used before those who are infected develop symptoms. One case-control study reported that controls used medical facemasks more often than cases infected with SARS-CoV (p < 0.05). No primary study on cloth facemask effectiveness to prevent respiratory infection transmission was found. CONCLUSION Based on the available evidence, medical facemask use by healthy and sick individuals is recommended for preventing respiratory infection transmission in community settings. Medical facemask effectiveness is dependent on compliance and utilization in combination with preventive measures such as intensive hand hygiene. No direct evidence is currently available in humans supporting the recommendation of cloth facemask use to prevent respiratory infection transmission.
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Affiliation(s)
- Karima Chaabna
- Institute for Population Health, Weill Cornell Medicine, Doha, Qatar.
| | | | - Ravinder Mamtani
- Institute for Population Health, Weill Cornell Medicine, Doha, Qatar
| | - Sohaila Cheema
- Institute for Population Health, Weill Cornell Medicine, Doha, Qatar
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14
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Li Y. Basic routes of transmission of respiratory pathogens-A new proposal for transmission categorization based on respiratory spray, inhalation, and touch. Indoor Air 2021; 31:3-6. [PMID: 33474779 PMCID: PMC8013452 DOI: 10.1111/ina.12786] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/26/2020] [Accepted: 12/15/2020] [Indexed: 05/05/2023]
Affiliation(s)
- Yuguo Li
- University of Hong KongHong KongHong Kong
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15
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Mahjoub Mohammed Merghani K, Sagot B, Gehin E, Da G, Motzkus C. A review on the applied techniques of exhaled airflow and droplets characterization. Indoor Air 2021; 31:7-25. [PMID: 33206424 PMCID: PMC7753802 DOI: 10.1111/ina.12770] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/06/2020] [Revised: 10/12/2020] [Accepted: 11/01/2020] [Indexed: 05/18/2023]
Abstract
In the last two decades, multidisciplinary research teams worked on developing a comprehensive understanding of the transmission mechanisms of airborne diseases. This article reviews the experimental studies on the characterization of the exhaled airflow and the droplets, comparing the measured parameters, the advantages, and the limitations of each technique. To characterize the airflow field, the global flow-field techniques-high-speed photography, schlieren photography, and PIV-are applied to visualize the shape and propagation of the exhaled airflow and its interaction with the ambient air, while the pointwise measurements provide quantitative measurements of the velocity, flow rate, humidity and temperature at a single point in the flow field. For the exhaled droplets, intrusive techniques are used to characterize the size distribution and concentration of the droplets' dry residues while non-intrusive techniques can measure the droplet size and velocity at different locations in the flow field. The evolution of droplets' size and velocity away from the source has not yet been thoroughly experimentally investigated. Besides, there is a lack of information about the temperature and humidity fields composed by the interaction of the exhaled airflow and the ambient air.
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16
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Wilmont S, Neu N, Hill-Ricciuti A, Alba L, Prill MM, Whitaker B, Garg S, Stone ND, Lu X, Kim L, Gerber SI, Larson E, Saiman L. Active surveillance for acute respiratory infections among pediatric long-term care facility staff. Am J Infect Control 2020; 48:1474-1477. [PMID: 32593809 PMCID: PMC7316056 DOI: 10.1016/j.ajic.2020.06.190] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
Staff at pediatric long-term care facilities (pLTCF) were responsive to electronic messages asking about acute respiratory illness symptoms. Staff in pLTCFs had respiratory viruses detected during acute respiratory infections and while asymptomatic. Contagious presenteeism occurred as some participants with ARIs worked while symptomatic. Staff with ARI may pose a risk of transmitting respiratory viral infections to frail and medically complex pLTCF residents.
Background Transmission of respiratory viruses between staff and residents of pediatric long-term care facilities (pLTCFs) can occur. We assessed the feasibility of using text or email messages to perform surveillance for acute respiratory infections (ARIs) among staff. Methods From December 7, 2016 to May 7, 2017, 50 staff participants from 2 pLTCFs received weekly text or email requests to report the presence or absence of ARI symptoms. Those who fulfilled the ARI case definition (≥2 symptoms) had respiratory specimens collected to detect viruses by reverse transcriptase polymerase chain reaction assays. Pre- and postsurveillance respiratory specimens were collected to assess subclinical viral shedding. Results The response rate to weekly electronic messages was 93%. Twenty-one ARIs reported from 20 (40%) participants fulfilled the case definition. Respiratory viruses were detected in 29% (5/17) of specimens collected at symptom onset (influenza B, respiratory syncytial virus, coronavirus [CoV] 229E, rhinovirus [RV], and dual detection of CoV OC43 and bocavirus). Four participants had positive presurveillance (4 RV), and 6 had positive postsurveillance specimens (3 RV, 2 CoV NL63, and 1 adenovirus). Conclusions Electronic messaging to conduct ARI surveillance among pLTCF staff was feasible.
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Affiliation(s)
- Sibyl Wilmont
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Natalie Neu
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | | | - Luis Alba
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Mila M Prill
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brett Whitaker
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA; Influenza Division, United States Public Health Service, Rockville, MD
| | - Nimalie D Stone
- Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xiaoyan Lu
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lindsay Kim
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA; Influenza Division, United States Public Health Service, Rockville, MD
| | - Susan I Gerber
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY; Department of Infection Prevention & Control, NewYork-Presbyterian Hospital, New York, NY.
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Brainard J, Jones NR, Lake IR, Hooper L, Hunter PR. Community use of face masks and similar barriers to prevent respiratory illness such as COVID-19: a rapid scoping review. Euro Surveill 2020; 25. [PMID: 33303066 DOI: 10.1101/2020.04.01.20049528] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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] [Indexed: 05/22/2023] Open
Abstract
BackgroundEvidence for face-mask wearing in the community to protect against respiratory disease is unclear.AimTo assess effectiveness of wearing face masks in the community to prevent respiratory disease, and recommend improvements to this evidence base.MethodsWe systematically searched Scopus, Embase and MEDLINE for studies evaluating respiratory disease incidence after face-mask wearing (or not). Narrative synthesis and random-effects meta-analysis of attack rates for primary and secondary prevention were performed, subgrouped by design, setting, face barrier type, and who wore the mask. Preferred outcome was influenza-like illness. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) quality assessment was undertaken and evidence base deficits described.Results33 studies (12 randomised control trials (RCTs)) were included. Mask wearing reduced primary infection by 6% (odds ratio (OR): 0.94; 95% CI: 0.75-1.19 for RCTs) to 61% (OR: 0.85; 95% CI: 0.32-2.27; OR: 0.39; 95% CI: 0.18-0.84 and OR: 0.61; 95% CI: 0.45-0.85 for cohort, case-control and cross-sectional studies respectively). RCTs suggested lowest secondary attack rates when both well and ill household members wore masks (OR: 0.81; 95% CI: 0.48-1.37). While RCTs might underestimate effects due to poor compliance and controls wearing masks, observational studies likely overestimate effects, as mask wearing might be associated with other risk-averse behaviours. GRADE was low or very low quality.ConclusionWearing face masks may reduce primary respiratory infection risk, probably by 6-15%. It is important to balance evidence from RCTs and observational studies when their conclusions widely differ and both are at risk of significant bias. COVID-19-specific studies are required.
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Affiliation(s)
- Julii Brainard
- The Norwich School of Medicine, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Natalia R Jones
- School of Environmental Sciences, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Iain R Lake
- School of Environmental Sciences, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Lee Hooper
- The Norwich School of Medicine, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Paul R Hunter
- The Norwich School of Medicine, University of East Anglia, Norwich, Norfolk, United Kingdom
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18
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Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, van Driel ML, Jones MA, Thorning S, Beller EM, Clark J, Hoffmann TC, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2020; 11:CD006207. [PMID: 33215698 DOI: 10.1101/2020.03.30.20047217] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review published in 2007, 2009, 2010, and 2011. The evidence summarised in this review does not include results from studies from the current COVID-19 pandemic. OBJECTIVES To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses. SEARCH METHODS We searched CENTRAL, PubMed, Embase, CINAHL on 1 April 2020. We searched ClinicalTrials.gov, and the WHO ICTRP on 16 March 2020. We conducted a backwards and forwards citation analysis on the newly included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs of trials investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, and gargling) to prevent respiratory virus transmission. In previous versions of this review we also included observational studies. However, for this update, there were sufficient RCTs to address our study aims. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. Three pairs of review authors independently extracted data using a standard template applied in previous versions of this review, but which was revised to reflect our focus on RCTs and cluster-RCTs for this update. We did not contact trialists for missing data due to the urgency in completing the review. We extracted data on adverse events (harms) associated with the interventions. MAIN RESULTS We included 44 new RCTs and cluster-RCTs in this update, bringing the total number of randomised trials to 67. There were no included studies conducted during the COVID-19 pandemic. Six ongoing studies were identified, of which three evaluating masks are being conducted concurrent with the COVID pandemic, and one is completed. Many studies were conducted during non-epidemic influenza periods, but several studies were conducted during the global H1N1 influenza pandemic in 2009, and others in epidemic influenza seasons up to 2016. Thus, studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID-19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high-income countries; crowded inner city settings in low-income countries; and an immigrant neighbourhood in a high-income country. Compliance with interventions was low in many studies. The risk of bias for the RCTs and cluster-RCTs was mostly high or unclear. Medical/surgical masks compared to no masks We included nine trials (of which eight were cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and seven in the community). There is low certainty evidence from nine trials (3507 participants) that wearing a mask may make little or no difference to the outcome of influenza-like illness (ILI) compared to not wearing a mask (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.82 to 1.18. There is moderate certainty evidence that wearing a mask probably makes little or no difference to the outcome of laboratory-confirmed influenza compared to not wearing a mask (RR 0.91, 95% CI 0.66 to 1.26; 6 trials; 3005 participants). Harms were rarely measured and poorly reported. Two studies during COVID-19 plan to recruit a total of 72,000 people. One evaluates medical/surgical masks (N = 6000) (published Annals of Internal Medicine, 18 Nov 2020), and one evaluates cloth masks (N = 66,000). N95/P2 respirators compared to medical/surgical masks We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). There is uncertainty over the effects of N95/P2 respirators when compared with medical/surgical masks on the outcomes of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; very low-certainty evidence; 3 trials; 7779 participants) and ILI (RR 0.82, 95% CI 0.66 to 1.03; low-certainty evidence; 5 trials; 8407 participants). The evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirator compared to a medical/surgical mask probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; moderate-certainty evidence; 5 trials; 8407 participants). Restricting the pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies. One ongoing study recruiting 576 people compares N95/P2 respirators with medical surgical masks for healthcare workers during COVID-19. Hand hygiene compared to control Settings included schools, childcare centres, homes, and offices. In a comparison of hand hygiene interventions with control (no intervention), there was a 16% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.84, 95% CI 0.82 to 0.86; 7 trials; 44,129 participants; moderate-certainty evidence), suggesting a probable benefit. When considering the more strictly defined outcomes of ILI and laboratory-confirmed influenza, the estimates of effect for ILI (RR 0.98, 95% CI 0.85 to 1.13; 10 trials; 32,641 participants; low-certainty evidence) and laboratory-confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials; 8332 participants; low-certainty evidence) suggest the intervention made little or no difference. We pooled all 16 trials (61,372 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. The pooled data showed that hand hygiene may offer a benefit with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.84 to 0.95; low-certainty evidence), but with high heterogeneity. Few trials measured and reported harms. There are two ongoing studies of handwashing interventions in 395 children outside of COVID-19. We identified one RCT on quarantine/physical distancing. Company employees in Japan were asked to stay at home if household members had ILI symptoms. Overall fewer people in the intervention group contracted influenza compared with workers in the control group (2.75% versus 3.18%; hazard ratio 0.80, 95% CI 0.66 to 0.97). However, those who stayed at home with their infected family members were 2.17 times more likely to be infected. We found no RCTs on eye protection, gowns and gloves, or screening at entry ports. AUTHORS' CONCLUSIONS The high risk of bias in the trials, variation in outcome measurement, and relatively low compliance with the interventions during the studies hamper drawing firm conclusions and generalising the findings to the current COVID-19 pandemic. There is uncertainty about the effects of face masks. The low-moderate certainty of the evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of randomised trials did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks during seasonal influenza. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness. Harms associated with physical interventions were under-investigated. There is a need for large, well-designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, especially in those most at risk of ARIs.
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Affiliation(s)
- Tom Jefferson
- Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Chris B Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Liz Dooley
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Regional Center for Epidemiology, Veneto Region, Padova, Italy
| | - Lubna A Al-Ansary
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghada A Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Sarah Thorning
- GCUH Library, Gold Coast Hospital and Health Service, Southport, Australia
| | - Elaine M Beller
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - John M Conly
- Cumming School of Medicine, University of Calgary, Room AGW5, SSB, Foothills Medical Centre, Calgary, Canada
- O'Brien Institute for Public Health and Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
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19
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Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, van Driel ML, Jones MA, Thorning S, Beller EM, Clark J, Hoffmann TC, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2020; 11:CD006207. [PMID: 33215698 PMCID: PMC8094623 DOI: 10.1002/14651858.cd006207.pub5] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review published in 2007, 2009, 2010, and 2011. The evidence summarised in this review does not include results from studies from the current COVID-19 pandemic. OBJECTIVES To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses. SEARCH METHODS We searched CENTRAL, PubMed, Embase, CINAHL on 1 April 2020. We searched ClinicalTrials.gov, and the WHO ICTRP on 16 March 2020. We conducted a backwards and forwards citation analysis on the newly included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs of trials investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, and gargling) to prevent respiratory virus transmission. In previous versions of this review we also included observational studies. However, for this update, there were sufficient RCTs to address our study aims. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. Three pairs of review authors independently extracted data using a standard template applied in previous versions of this review, but which was revised to reflect our focus on RCTs and cluster-RCTs for this update. We did not contact trialists for missing data due to the urgency in completing the review. We extracted data on adverse events (harms) associated with the interventions. MAIN RESULTS We included 44 new RCTs and cluster-RCTs in this update, bringing the total number of randomised trials to 67. There were no included studies conducted during the COVID-19 pandemic. Six ongoing studies were identified, of which three evaluating masks are being conducted concurrent with the COVID pandemic, and one is completed. Many studies were conducted during non-epidemic influenza periods, but several studies were conducted during the global H1N1 influenza pandemic in 2009, and others in epidemic influenza seasons up to 2016. Thus, studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID-19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high-income countries; crowded inner city settings in low-income countries; and an immigrant neighbourhood in a high-income country. Compliance with interventions was low in many studies. The risk of bias for the RCTs and cluster-RCTs was mostly high or unclear. Medical/surgical masks compared to no masks We included nine trials (of which eight were cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and seven in the community). There is low certainty evidence from nine trials (3507 participants) that wearing a mask may make little or no difference to the outcome of influenza-like illness (ILI) compared to not wearing a mask (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.82 to 1.18. There is moderate certainty evidence that wearing a mask probably makes little or no difference to the outcome of laboratory-confirmed influenza compared to not wearing a mask (RR 0.91, 95% CI 0.66 to 1.26; 6 trials; 3005 participants). Harms were rarely measured and poorly reported. Two studies during COVID-19 plan to recruit a total of 72,000 people. One evaluates medical/surgical masks (N = 6000) (published Annals of Internal Medicine, 18 Nov 2020), and one evaluates cloth masks (N = 66,000). N95/P2 respirators compared to medical/surgical masks We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). There is uncertainty over the effects of N95/P2 respirators when compared with medical/surgical masks on the outcomes of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; very low-certainty evidence; 3 trials; 7779 participants) and ILI (RR 0.82, 95% CI 0.66 to 1.03; low-certainty evidence; 5 trials; 8407 participants). The evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirator compared to a medical/surgical mask probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; moderate-certainty evidence; 5 trials; 8407 participants). Restricting the pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies. One ongoing study recruiting 576 people compares N95/P2 respirators with medical surgical masks for healthcare workers during COVID-19. Hand hygiene compared to control Settings included schools, childcare centres, homes, and offices. In a comparison of hand hygiene interventions with control (no intervention), there was a 16% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.84, 95% CI 0.82 to 0.86; 7 trials; 44,129 participants; moderate-certainty evidence), suggesting a probable benefit. When considering the more strictly defined outcomes of ILI and laboratory-confirmed influenza, the estimates of effect for ILI (RR 0.98, 95% CI 0.85 to 1.13; 10 trials; 32,641 participants; low-certainty evidence) and laboratory-confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials; 8332 participants; low-certainty evidence) suggest the intervention made little or no difference. We pooled all 16 trials (61,372 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. The pooled data showed that hand hygiene may offer a benefit with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.84 to 0.95; low-certainty evidence), but with high heterogeneity. Few trials measured and reported harms. There are two ongoing studies of handwashing interventions in 395 children outside of COVID-19. We identified one RCT on quarantine/physical distancing. Company employees in Japan were asked to stay at home if household members had ILI symptoms. Overall fewer people in the intervention group contracted influenza compared with workers in the control group (2.75% versus 3.18%; hazard ratio 0.80, 95% CI 0.66 to 0.97). However, those who stayed at home with their infected family members were 2.17 times more likely to be infected. We found no RCTs on eye protection, gowns and gloves, or screening at entry ports. AUTHORS' CONCLUSIONS The high risk of bias in the trials, variation in outcome measurement, and relatively low compliance with the interventions during the studies hamper drawing firm conclusions and generalising the findings to the current COVID-19 pandemic. There is uncertainty about the effects of face masks. The low-moderate certainty of the evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of randomised trials did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks during seasonal influenza. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness. Harms associated with physical interventions were under-investigated. There is a need for large, well-designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, especially in those most at risk of ARIs.
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Affiliation(s)
- Tom Jefferson
- Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Chris B Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Liz Dooley
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Regional Center for Epidemiology, Veneto Region, Padova, Italy
| | - Lubna A Al-Ansary
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghada A Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Sarah Thorning
- GCUH Library, Gold Coast Hospital and Health Service, Southport, Australia
| | - Elaine M Beller
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - John M Conly
- Cumming School of Medicine, University of Calgary, Room AGW5, SSB, Foothills Medical Centre, Calgary, Canada
- O'Brien Institute for Public Health and Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
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Mohapatra RK, Pintilie L, Kandi V, Sarangi AK, Das D, Sahu R, Perekhoda L. The recent challenges of highly contagious COVID-19, causing respiratory infections: Symptoms, diagnosis, transmission, possible vaccines, animal models, and immunotherapy. Chem Biol Drug Des 2020. [PMID: 32654267 DOI: 10.1111/cbdd.v96.510.1111/cbdd.13761] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
COVID-19 is highly contagious pathogenic viral infection initiated from Wuhan seafood wholesale market of China on December 2019 and spread rapidly around the whole world due to onward transmission. This recent outbreak of novel coronavirus (CoV) was believed to be originated from bats and causing respiratory infections such as common cold, dry cough, fever, headache, dyspnea, pneumonia, and finally Severe Acute Respiratory Syndrome (SARS) in humans. For this widespread zoonotic virus, human-to-human transmission has resulted in nearly 83 lakh cases in 213 countries and territories with 4,50,686 deaths as on 19 June 2020. This review presents a report on the origin, transmission, symptoms, diagnosis, possible vaccines, animal models, and immunotherapy for this novel virus and will provide ample references for the researchers toward the ongoing development of therapeutic agents and vaccines and also preventing the spread of this disease.
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Affiliation(s)
- Ranjan K Mohapatra
- Department of Chemistry, Government College of Engineering, Keonjhar, Odisha, India
| | - Lucia Pintilie
- Department of Synthesis of Bioactive Substances and Pharmaceutical Technologies, National Institute for Chemical and Pharmaceutical Research and Development, Bucharest, Romania
| | - Venkataramana Kandi
- Department of Microbiology, Pratima Institute of Medical Sciences, Karimnagar, Hyderabad, India
| | - Ashish K Sarangi
- Department of Chemistry, School of Applied Sciences, Centurion University of Technology and Management, Odisha, India
| | - Debadutta Das
- Department of Chemistry, Sukanti Degree College, Subarnapur, Odisha, India
| | - Raghaba Sahu
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Lina Perekhoda
- Department of medicinal chemistry, National University of Pharmacy, Kharkiv, Ukraine
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Chetty T, Daniels BB, Ngandu NK, Goga A. A rapid review of the effectiveness of screening practices at airports, land borders and ports to reduce the transmission of respiratory infectious diseases such as COVID-19. S Afr Med J 2020; 110:1105-1109. [PMID: 33403987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Travel screening for infectious diseases is often implemented to delay or prevent the entry of infected persons to a country/area. OBJECTIVES To evaluate the effectiveness of different point-of-entry screening strategies in achieving a reduction in imported COVID-19 transmission. METHODS A rapid evidence review was conducted, systematically searching PubMed and Google Scholar and grey literature on 27 March 2020. RESULTS We screened 1 194 records. Nine potential full-text articles were assessed for eligibility and included. Three articles investigated the effectiveness of entry-based thermal and body temperature scanning. Entry-based infrared thermal or body temperature scanning for COVID-19 was unlikely to be effective. Two systematic reviews found no additional benefit of travel restrictions/screening. In a COVID-19 modelling study, airport screening was not effective, with exit and entry thermal scanning identifying half and missing almost half of infected travellers. Two other modelling studies found that entry-based travel screening would achieve only modest delays in community transmission, while international travel quarantine could reduce case importations by 80%. CONCLUSIONS There is insufficient evidence to support entry and exit screening at points of entry, as these strategies detect just over half of the infected cases, missing almost half at entry points. The benefits of airport screening therefore need to be context specific and weighed against the resources and cost of implementation, the contribution of imported cases to total cases, and the benefits of identifying 50% of cases in the South African context with the country's high HIV and tuberculosis prevalence and limited resources to deal with a pandemic of this nature.
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Affiliation(s)
- T Chetty
- Health Systems Research Unit, South African Medical Research Council, Durban, South Africa.
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22
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Phu HT, Park Y, Andrews AJ, Marabella I, Abraham A, Mimmack R, Olson BA, Chaika J, Floersch E, Remskar M, Hume JR, Fischer GA, Belani K, Hogan CJ. Design and evaluation of a portable negative pressure hood with HEPA filtration to protect health care workers treating patients with transmissible respiratory infections. Am J Infect Control 2020; 48:1237-1243. [PMID: 32603849 PMCID: PMC7320700 DOI: 10.1016/j.ajic.2020.06.203] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 01/25/2023]
Abstract
Background To mitigate potential exposure of healthcare workers (HCWs) to SARS-CoV-2 via aerosol routes, we have developed a portable hood which not only creates a barrier between HCW and patient, but also utilizes negative pressure with filtration of aerosols by a high-efficiency particulate air filter. Material and Methods The hood has iris-port openings for access to the patient, and an opening large enough for a patient's head and upper torso. The top of the hood is a high-efficiency particulate air filter connected to a blower to apply negative pressure. We determined the aerosol penetration from outside to inside in laboratory experiments. Results The penetration of particles from within the hood to the breathing zones of HCWs outside the hood was near 10-4 (0.01%) in the 200-400 nm size range, and near 10−3 (0.1%) for smaller particles. Penetration values for particles in the 500 nm-5 μm range were below 10−2 (1%). Fluorometric analysis of deposited fluorescein particles on the personal protective equipment of an HCW revealed that negative pressure reduces particle deposition both outside and inside the hood. Conclusions We find that negative pressure hoods can be effective controls to mitigate aerosol exposure to HCWs, while simultaneously allowing access to patients.
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Affiliation(s)
- Hai-Thien Phu
- University of Minnesota Medical School, Department of Pediatrics, Minneapolis, MN; University of Minnesota Medical School, Division of General Internal Medicine, Minneapolis, MN
| | - Yensil Park
- University of Minnesota, Department of Mechanical Engineering, Minneapolis, MN
| | - Austin J Andrews
- University of Minnesota, Department of Mechanical Engineering, Minneapolis, MN
| | - Ian Marabella
- University of Minnesota, Department of Mechanical Engineering, Minneapolis, MN
| | - Asish Abraham
- University of Minnesota Medical School, Department of Anesthesiology, Minneapolis, MN
| | - Reid Mimmack
- University of Minnesota Medical School, Minneapolis, MN
| | - Bernard A Olson
- University of Minnesota, Department of Mechanical Engineering, Minneapolis, MN
| | | | | | - Mojca Remskar
- University of Minnesota Medical School, Department of Anesthesiology, Minneapolis, MN; University of Minnesota, M Simulation, Minneapolis, MN
| | - Janet R Hume
- University of Minnesota Medical School, Department of Pediatrics, Minneapolis, MN
| | - Gwenyth A Fischer
- University of Minnesota Medical School, Department of Pediatrics, Minneapolis, MN
| | - Kumar Belani
- University of Minnesota Medical School, Department of Anesthesiology, Minneapolis, MN.
| | - Christopher J Hogan
- University of Minnesota, Department of Mechanical Engineering, Minneapolis, MN.
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23
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Abstract
The seasonal cycle of respiratory viral diseases has been widely recognized for thousands of years, as annual epidemics of the common cold and influenza disease hit the human population like clockwork in the winter season in temperate regions. Moreover, epidemics caused by viruses such as severe acute respiratory syndrome coronavirus (SARS-CoV) and the newly emerging SARS-CoV-2 occur during the winter months. The mechanisms underlying the seasonal nature of respiratory viral infections have been examined and debated for many years. The two major contributing factors are the changes in environmental parameters and human behavior. Studies have revealed the effect of temperature and humidity on respiratory virus stability and transmission rates. More recent research highlights the importance of the environmental factors, especially temperature and humidity, in modulating host intrinsic, innate, and adaptive immune responses to viral infections in the respiratory tract. Here we review evidence of how outdoor and indoor climates are linked to the seasonality of viral respiratory infections. We further discuss determinants of host response in the seasonality of respiratory viruses by highlighting recent studies in the field.
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Affiliation(s)
- Miyu Moriyama
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut 06520, USA;
| | - Walter J Hugentobler
- Institute of Primary Care, University of Zurich and University Hospital, Zurich, Switzerland CH-8091
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut 06520, USA;
- Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, Connecticut 06512, USA
- Howard Hughes Medical Institute, Chevy Chase, Maryland 20815, USA
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24
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Affiliation(s)
- Nicholas Clements
- Well Living Lab, Rochester, Minnesota; Mayo Clinic, College of Medicine, Rochester, Minnesota
| | - Matthew J Binnicker
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Véronique L Roger
- Well Living Lab, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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25
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Zhang N, Chen W, Chan PT, Yen HL, Tang JWT, Li Y. Close contact behavior in indoor environment and transmission of respiratory infection. Indoor Air 2020; 30:645-661. [PMID: 32259319 DOI: 10.1111/ina.12673] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/29/2020] [Accepted: 03/25/2020] [Indexed: 05/05/2023]
Abstract
Close contact was first identified as the primary route of transmission for most respiratory infections in the early 20th century. In this review, we synthesize the existing understanding of the mechanisms of close contact transmission. We focus on two issues: the mechanism of transmission in close contact, namely the transmission of the expired particles between two people, and the physical parameters of close contact that affect the exposure of particles from one individual to another, or how the nature of close contact plays a role in transmission. We propose the existence of three sub-routes of transmission: short-range airborne, large droplets, and immediate body-surface contact. We also distinguish a "body contact," which is defined with an interpersonal distance of zero, from a close contact. We demonstrate herein that the short-range airborne sub-route may be most common. The timescales over which data should be collected to assess the transmission risk during close contact events are much shorter than those required for the distant airborne or fomite routes. The current paucity of high-resolution data over short distances and timescales makes it very difficult to assess the risk of infection in these circumstances.
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Affiliation(s)
- Nan Zhang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Wenzhao Chen
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Pak-To Chan
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Hui-Ling Yen
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Julian Wei-Tze Tang
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
- Respiratory Sciences, University of Leicester, Leicester, UK
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
- School of Public Health, The University of Hong Kong, Hong Kong, China
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26
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Treffon J, Fotiadis SA, van Alen S, Becker K, Kahl BC. The Virulence Potential of Livestock-Associated Methicillin-Resistant Staphylococcus aureus Cultured from the Airways of Cystic Fibrosis Patients. Toxins (Basel) 2020; 12:E360. [PMID: 32486247 PMCID: PMC7354617 DOI: 10.3390/toxins12060360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/08/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 01/25/2023] Open
Abstract
Staphylococcus aureus is one of the most common pathogens that infects the airways of patients with cystic fibrosis (CF) and contributes to respiratory failure. Recently, livestock-associated methicillin-resistant S. aureus (LA-MRSA), usually cultured in farm animals, were detected in CF airways. Although some of these strains are able to establish severe infections in humans, there is limited knowledge about the role of LA-MRSA virulence in CF lung disease. To address this issue, we analyzed LA-MRSA, hospital-associated (HA-) MRSA and methicillin-susceptible S.aureus (MSSA) clinical isolates recovered early in the course of airway infection and several years after persistence in this hostile environment from pulmonary specimens of nine CF patients regarding important virulence traits such as their hemolytic activity, biofilm formation, invasion in airway epithelial cells, cytotoxicity, and antibiotic susceptibility. We detected that CF LA-MRSA isolates were resistant to tetracycline, more hemolytic and cytotoxic than HA-MRSA, and more invasive than MSSA. Despite the residence in the animal host, LA-MRSA still represent a serious threat to humans, as such clones possess a virulence potential similar or even higher than that of HA-MRSA. Furthermore, we confirmed that S. aureus individually adapts to the airways of CF patients, which eventually impedes the success of antistaphylococcal therapy of airway infections in CF.
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Affiliation(s)
- Janina Treffon
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (J.T.); (S.A.F.); (S.v.A.); (K.B.)
- Institute of Hygiene, University Hospital Münster, 48149 Münster, Germany
| | - Sarah Ann Fotiadis
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (J.T.); (S.A.F.); (S.v.A.); (K.B.)
| | - Sarah van Alen
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (J.T.); (S.A.F.); (S.v.A.); (K.B.)
- Business Unit Pain, Grünenthal GmbH, 52222 Stolberg, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (J.T.); (S.A.F.); (S.v.A.); (K.B.)
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Barbara C. Kahl
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (J.T.); (S.A.F.); (S.v.A.); (K.B.)
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27
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Zhen J, Chan C, Schoonees A, Apatu E, Thabane L, Young T. Transmission of respiratory viruses when using public ground transport: A rapid review to inform public health recommendations during the COVID-19 pandemic. S Afr Med J 2020. [PMID: 32880558 DOI: 10.7196/samj.2020.v110i6.14751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
In response to the COVID-19 pandemic, numerous countries worldwide declared national states of emergency and implemented interventions to minimise the risk of transmission among the public. Evidence was needed to inform strategies for limiting COVID-19 transmission on public transport. On 20 March 2020, we searched MEDLINE, CENTRAL, Web of Science and the World Health Organization's database of 'Global research on coronavirus disease (COVID-19)' to conduct a rapid review on interventions that reduce viral transmission on public ground transport. After screening 74 records, we identified 4 eligible studies. These studies suggest an increased risk of viral transmission with public transportation use that may be reduced with improved ventilation. International and national guidelines suggest the following strategies: keep the public informed, stay at home when sick, and minimise public transport use. Where use is unavoidable, environmental control, respiratory etiquette and hand hygiene are recommended, while a risk-based approach needs to guide the use of non-medical masks.
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Affiliation(s)
- J Zhen
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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28
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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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30
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Jing S, Zhang J, Cao M, Liu M, Yan Y, Zhao S, Cao N, Ou J, Ma K, Cai X, Wu J, Mei YF, Zhang Q. Household Transmission of Human Adenovirus Type 55 in Case of Fatal Acute Respiratory Disease. Emerg Infect Dis 2020; 25:1756-1758. [PMID: 31441750 PMCID: PMC6711205 DOI: 10.3201/eid2509.181937] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
We identified a case of fatal acute respiratory disease from household transmission of human adenovirus type 55 (HAdV-55) in Anhui Province, China. Computed tomography showed severe pneumonia. Comparative genomic analysis of HAdV-55 indicated the virus possibly originated in Shanxi Province, China. More attention should be paid to highly contagious HAdV-55.
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31
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Asadi S, Wexler AS, Cappa CD, Barreda S, Bouvier NM, Ristenpart WD. Effect of voicing and articulation manner on aerosol particle emission during human speech. PLoS One 2020; 15:e0227699. [PMID: 31986165 PMCID: PMC6984704 DOI: 10.1371/journal.pone.0227699] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [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: 07/17/2019] [Accepted: 12/24/2019] [Indexed: 12/30/2022] Open
Abstract
Previously, we demonstrated a strong correlation between the amplitude of human speech and the emission rate of micron-scale expiratory aerosol particles, which are believed to play a role in respiratory disease transmission. To further those findings, here we systematically investigate the effect of different 'phones' (the basic sound units of speech) on the emission of particles from the human respiratory tract during speech. We measured the respiratory particle emission rates of 56 healthy human volunteers voicing specific phones, both in isolation and in the context of a standard spoken text. We found that certain phones are associated with significantly higher particle production; for example, the vowel /i/ ("need," "sea") produces more particles than /ɑ/ ("saw," "hot") or /u/ ("blue," "mood"), while disyllabic words including voiced plosive consonants (e.g., /d/, /b/, /g/) yield more particles than words with voiceless fricatives (e.g., /s/, /h/, /f/). These trends for discrete phones and words were corroborated by the time-resolved particle emission rates as volunteers read aloud from a standard text passage that incorporates a broad range of the phones present in spoken English. Our measurements showed that particle emission rates were positively correlated with the vowel content of a phrase; conversely, particle emission decreased during phrases with a high fraction of voiceless fricatives. Our particle emission data is broadly consistent with prior measurements of the egressive airflow rate associated with the vocalization of various phones that differ in voicing and articulation. These results suggest that airborne transmission of respiratory pathogens via speech aerosol particles could be modulated by specific phonetic characteristics of the language spoken by a given human population, along with other, more frequently considered epidemiological variables.
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Affiliation(s)
- Sima Asadi
- Dept. of Chemical Engineering, University of California Davis, Davis, California, United States of America
| | - Anthony S. Wexler
- Dept. of Mechanical and Aerospace Engineering, University of California Davis, Davis, California, United States of America
- Air Quality Research Center, University of California Davis, Davis, California, United States of America
- Dept. of Civil and Environmental Engineering, University of California Davis, Davis, California, United States of America
- Dept. of Land, Air and Water Resources, University of California Davis, Davis, California, United States of America
| | - Christopher D. Cappa
- Dept. of Civil and Environmental Engineering, University of California Davis, Davis, California, United States of America
| | - Santiago Barreda
- Dept. of Linguistics, University of California Davis, Davis, California, United States of America
| | - Nicole M. Bouvier
- Div. of Infectious Diseases, Dept. of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Dept. of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - William D. Ristenpart
- Dept. of Chemical Engineering, University of California Davis, Davis, California, United States of America
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32
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Lindsley WG, Blachere FM, McClelland TL, Neu DT, Mnatsakanova A, Martin SB, Mead KR, Noti JD. Efficacy of an ambulance ventilation system in reducing EMS worker exposure to airborne particles from a patient cough aerosol simulator. J Occup Environ Hyg 2019; 16:804-816. [PMID: 31638865 DOI: 10.1080/15459624.2019.1674858] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The protection of emergency medical service (EMS) workers from airborne disease transmission is important during routine transport of patients with infectious respiratory illnesses and would be critical during a pandemic of a disease such as influenza. However, few studies have examined the effectiveness of ambulance ventilation systems at reducing EMS worker exposure to airborne particles (aerosols). In our study, a cough aerosol simulator mimicking a coughing patient with an infectious respiratory illness was placed on a patient cot in an ambulance. The concentration and dispersion of cough aerosol particles were measured for 15 min at locations corresponding to likely positions of an EMS worker treating the patient. Experiments were performed with the patient cot at an angle of 0° (horizontal), 30°, and 60°, and with the ambulance ventilation system set to 0, 5, and 12 air changes/hour (ACH). Our results showed that increasing the air change rate significantly reduced the airborne particle concentration (p < 0.001). Increasing the air change rate from 0 to 5 ACH reduced the mean aerosol concentration by 34% (SD = 19%) overall, while increasing it from 0 to 12 ACH reduced the concentration by 68% (SD = 9%). Changing the cot angle also affected the concentration (p < 0.001), but the effect was more modest, especially at 5 and 12 ACH. Contrary to our expectations, the aerosol concentrations at the different worker positions were not significantly different (p < 0.556). Flow visualization experiments showed that the ventilation system created a recirculation pattern which helped disperse the aerosol particles throughout the compartment, reducing the effectiveness of the system. Our findings indicate that the ambulance ventilation system reduced but did not eliminate worker exposure to infectious aerosol particles. Aerosol exposures were not significantly different at different locations within the compartment, including locations behind and beside the patient. Improved ventilation system designs with smoother and more unidirectional airflows could provide better worker protection.
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Affiliation(s)
- William G Lindsley
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Francoise M Blachere
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Tia L McClelland
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Dylan T Neu
- Division of Field Studies & Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Anna Mnatsakanova
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Stephen B Martin
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Kenneth R Mead
- Division of Field Studies & Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - John D Noti
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
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33
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Phan LT, Maita D, Mortiz DC, Bleasdale SC, Jones RM. Environmental Contact and Self-contact Patterns of Healthcare Workers: Implications for Infection Prevention and Control. Clin Infect Dis 2019; 69:S178-S184. [PMID: 31517975 PMCID: PMC6761362 DOI: 10.1093/cid/ciz558] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Respiratory viruses on fomites can be transferred to sites susceptible to infection via contact by hands or other fomites. METHODS Care for hospitalized patients with viral respiratory infections was observed in the patient room for 3-hour periods at an acute care academic medical center for over a 2 year period. One trained observer recorded the healthcare activities performed, contacts with fomites, and self-contacts made by healthcare workers (HCWs), while another observer recorded fomite contacts of patients during the encounter using predefined checklists. RESULTS The surface contacted by HCWs during the majority of visits was the patient (90%). Environmental surfaces contacted by HCWs frequently during healthcare activities included the tray table (48%), bed surface (41%), bed rail (41%), computer station (37%), and intravenous pole (32%). HCWs touched their own torso and mask in 32% and 29% of the visits, respectively. HCWs' self-contacts differed significantly among HCW job roles, with providers and respiratory therapists contacting themselves significantly more times than nurses and nurse technicians (P < .05). When HCWs performed only 1 care activity, there were significant differences in the number of patient contacts and self-contacts that HCWs made during performance of multiple care activities (P < .05). CONCLUSIONS HCWs regularly contact environmental surfaces, patients, and themselves while providing care to patients with infectious diseases, varying among care activities and HCW job roles. These contacts may facilitate the transmission of infection to HCWs and susceptible patients.
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Affiliation(s)
- Linh T Phan
- School of Public Health, University of Illinois at Chicago
| | - Dayana Maita
- College of Medicine, University of Illinois at Chicago
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Radonovich LJ, Simberkoff MS, Bessesen MT, Brown AC, Cummings DAT, Gaydos CA, Los JG, Krosche AE, Gibert CL, Gorse GJ, Nyquist AC, Reich NG, Rodriguez-Barradas MC, Price CS, Perl TM. N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial. JAMA 2019; 322:824-833. [PMID: 31479137 PMCID: PMC6724169 DOI: 10.1001/jama.2019.11645] [Citation(s) in RCA: 295] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/25/2019] [Indexed: 01/04/2023]
Abstract
Importance Clinical studies have been inconclusive about the effectiveness of N95 respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral respiratory infections. Objective To compare the effect of N95 respirators vs medical masks for prevention of influenza and other viral respiratory infections among HCP. Design, Setting, and Participants A cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 respirator or medical mask groups. Interventions Overall, 1993 participants in 189 clusters were randomly assigned to wear N95 respirators (2512 HCP-seasons of observation) and 2058 in 191 clusters were randomly assigned to wear medical masks (2668 HCP-seasons) when near patients with respiratory illness. Main Outcomes and Measures The primary outcome was the incidence of laboratory-confirmed influenza. Secondary outcomes included incidence of acute respiratory illness, laboratory-detected respiratory infections, laboratory-confirmed respiratory illness, and influenzalike illness. Adherence to interventions was assessed. Results Among 2862 randomized participants (mean [SD] age, 43 [11.5] years; 2369 [82.8%]) women), 2371 completed the study and accounted for 5180 HCP-seasons. There were 207 laboratory-confirmed influenza infection events (8.2% of HCP-seasons) in the N95 respirator group and 193 (7.2% of HCP-seasons) in the medical mask group (difference, 1.0%, [95% CI, -0.5% to 2.5%]; P = .18) (adjusted odds ratio [OR], 1.18 [95% CI, 0.95-1.45]). There were 1556 acute respiratory illness events in the respirator group vs 1711 in the mask group (difference, -21.9 per 1000 HCP-seasons [95% CI, -48.2 to 4.4]; P = .10); 679 laboratory-detected respiratory infections in the respirator group vs 745 in the mask group (difference, -8.9 per 1000 HCP-seasons, [95% CI, -33.3 to 15.4]; P = .47); 371 laboratory-confirmed respiratory illness events in the respirator group vs 417 in the mask group (difference, -8.6 per 1000 HCP-seasons [95% CI, -28.2 to 10.9]; P = .39); and 128 influenzalike illness events in the respirator group vs 166 in the mask group (difference, -11.3 per 1000 HCP-seasons [95% CI, -23.8 to 1.3]; P = .08). In the respirator group, 89.4% of participants reported "always" or "sometimes" wearing their assigned devices vs 90.2% in the mask group. Conclusions and Relevance Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza. Trial Registration ClinicalTrials.gov Identifier: NCT01249625.
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Affiliation(s)
- Lewis J. Radonovich
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
| | - Michael S. Simberkoff
- Veterans Affairs New York Harbor Healthcare System, New York
- New York University School of Medicine, New York
| | - Mary T. Bessesen
- Veterans Affairs Eastern Colorado Healthcare System, Denver
- University of Colorado School of Medicine, Aurora
| | | | - Derek A. T. Cummings
- University of Florida, Gainesville
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jenna G. Los
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amanda E. Krosche
- Johns Hopkins School of Medicine, Baltimore, Maryland
- Weill Cornell Medicine, New York, New York
| | - Cynthia L. Gibert
- Veterans Affairs Medical Center, Washington, DC
- George Washington University School of Medical and Health Sciences, Washington, DC
| | - Geoffrey J. Gorse
- Veterans Affairs St Louis Healthcare System, St Louis, Missouri
- St Louis University School of Medicine, St Louis, Missouri
| | - Ann-Christine Nyquist
- University of Colorado School of Medicine, Aurora
- Children’s Hospital Colorado, Aurora
| | | | - Maria C. Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Connie Savor Price
- University of Colorado School of Medicine, Aurora
- Denver Health Medical Center, Denver, Colorado
| | - Trish M. Perl
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- University of Texas Southwestern Medical Center, Dallas
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Abstract
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in infants and young children. Despite its substantial disease burden, no effective vaccine is available. Clinical manifestations of RSV encompass the spectrum of acute upper and lower respiratory tract infection. Hallmarks of the virus are its propensity to progress to lower respiratory disease and to cause disproportionate disease severity at extremes of ages. Acute RSV infection may be complicated by secondary bacterial infections and respiratory failure requiring mechanical ventilation and prolonged hospitalization. In the developed world, most RSV infections are self-limited; however, globally, RSV is a significant cause of mortality in children younger than age 5 years. Severe RSV infection in infancy has also been associated with the development of childhood asthma. Thus, the extensive disease burden of RSV and its attributable mortality portend the urgency of vaccine development targeted toward populations disproportionately affected by severe disease. [Pediatr Ann. 2019;48(9):e349-e353.].
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Arguedas YN, Santana-Cibrian M, Velasco-Hernández JX. Transmission dynamics of acute respiratory diseases in a population structured by age. Math Biosci Eng 2019; 16:7477-7493. [PMID: 31698624 DOI: 10.3934/mbe.2019375] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Determining the role of age on the transmission of an infection is a topic that has received significant attention. In this work, a dataset of acute respiratory infections structured by age from San Luis Potosí, Mexico, is analyzed to understand the age impact on this class of diseases. To do that, a compartmental SEIRS multigroup model is proposed to describe the infection dynamics among age groups. Then, a Bayesian inference approach is used to estimate relevant parameters in the model such as the probability of infection, the average time that one individual remains infectious, the average time that one individual remains immune, and the force of infection, among others. Based on those estimates, our analysis leads us to conclude that children less than 5 years old are the primary spreaders of respiratory infections in San Luis Potosí's population from 2000 to 2008 since they are more prone to get sick, remain infectious for longer periods and they are reinfected more rapidly. On the other hand, the group of young adults (20-59) is the one that differs the most from the little children's group because it does not get sick often, it remains infectious only a few days and it stays healthy for longer periods. These observations allow us to infer that the group of young adults is the one that, on average, less contributed to the spread of this class of infections during the years represented in our database.
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Affiliation(s)
- Yendry N Arguedas
- Instituto de Matemáticas UNAM (Unidad Juriquilla), Blvd. Juriquilla 3001, Juriquilla, Querétaro, C.P. 76230, Mexico
| | - Mario Santana-Cibrian
- CONACYT-Instituto de Matemáticas UNAM (Unidad Juriquilla), Blvd. Juriquilla 3001, Juriquilla, Querétaro, C.P. 76230, Mexico
| | - Jorge X Velasco-Hernández
- Instituto de Matemáticas UNAM (Unidad Juriquilla), Blvd. Juriquilla 3001, Juriquilla, Querétaro, C.P. 76230, Mexico
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Zhang N, Tang JW, Li Y. Human behavior during close contact in a graduate student office. Indoor Air 2019; 29:577-590. [PMID: 30908707 DOI: 10.1111/ina.12554] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/01/2019] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Abstract
Close contact is a part of daily life, and proximity is known to play a primary role in the transmission of many respiratory infections. However, there are no data on close contact parameters such as movement of the head/body and relative location, which can affect both expiration and inspiration flows. Using video cameras, we collected such data for nearly 63 000 seconds of total close contact duration in a graduate student office in Beijing, China. Each student had on average 9.6 close contacts per hour and spent 9.9% of their time participating in close contact interactions. Males made more body/head movements than females during close contact. The probability distribution of interpersonal distance follows a log-normal distribution. The average interpersonal distance was 0.67 m. Students preferred a relative face orientation angle between 15° and 45°. When the relative face orientation angle increased, the interpersonal distance increased. Students had a high probability (73%-97%) of maintaining their head, body, and relative position during close contact, while the probability of body/head or relative position changing from any location/angle to another is also given. These data may be used for assessment of infection risk via close contact in crowded indoor environments.
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Affiliation(s)
- Nan Zhang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Julian W Tang
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
- Infection, Immunity, Inflammation, University of Leicester, Leicester, UK
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
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Cavalera MA, Colella V, Napoli E, Arfuso F, Panarese R, Brianti E, Otranto D. Shedding of feline lungworm larvae and their infectivity to snail intermediate hosts after anthelmintic treatment. Int J Parasitol 2019; 49:449-453. [PMID: 30904621 DOI: 10.1016/j.ijpara.2018.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/12/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/17/2022]
Abstract
Aelurostrongylus abstrusus and Troglostrongylus brevior are snail-transmitted helminths causing respiratory diseases in infected cats. The shedding of feline lungworm L1s and their infectivity to the snail intermediate host, after administration of anthelminthic products to cats, are poorly documented. To assess the efficacy of 8.3% fipronil, 10% (S)-methoprene, 0.4% eprinomectin and 8.3% praziquantel (i.e. eprinomectin formulation) and 10% imidacloprid/1% moxidectin (i.e. moxidectin formulation) against these nematodes and to determine the number of days post-treatment until viable L1s are released in the faeces, 384 animals were screened by faecal examination. Of the 54 positive animals (i.e., 14.1%; 7.3% A. abstrusus, 6.2% T. brevior and 0.5% coinfected), 36 were randomly allocated to four groups. Groups A and B were composed of cats positive for T. brevior and treated with the eprinomectin and with the moxidectin formulations, respectively, whereas cats in groups C and D were positive to A. abstrusus and treated with the eprinomectin and the moxidectin formulations, respectively. Prior to and every day after treatment, faecal samples were analysed by the Baermann technique and the number of larvae per gram of faeces determined, and again four weeks after treatment, to assess the efficacy of a single administration of the products. In addition, to evaluate the pre- and post-treatment infectivity of L1s to snail intermediate hosts, one/two snails per cat were infected with 100 L1s collected from the faeces of enrolled animals and then digested 28 days p.i. Based on L1s faecal counts, the efficacy of the eprinomectin and the moxidectin formulations at 28 days was 100% for both A. abstrusus and T. brevior, with a mean number of days of 7.9 ± 1.2 in group A, 7.8 ± 1.9 in B, 6.9 ± 1.6 in C and 8.9 ± 2.0 in D to become negative. Following the artificial digestion, active L3s of T. brevior and A. abstrusus were found in 160 (87.4%) experimentally infected snails. The results of this study demonstrate that a single administration of the two formulations is effective in the treatment of A. abstrusus and T. brevior infections and that during the post-treatment period live L1s are shed for up to 8.9 ± 2.0 days. L1s of both lungworm species released in the faeces after drug administration are still able to reach the infective larval stage in the infected snails. Hence, preventative measures after the treatment of infected animals should include keeping cats indoors and disposal of their faeces for approximately 10 days to avoid environmental contamination and infection of gastropod intermediate hosts.
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Affiliation(s)
| | - Vito Colella
- Dipartimento di Medicina Veterinaria, Università di Bari, 70010, Valenzano, Bari, Italy
| | - Ettore Napoli
- Dipartimento di Scienze Veterinarie, Università di Messina, 98168, Messina, Italy
| | - Francesca Arfuso
- Dipartimento di Scienze Veterinarie, Università di Messina, 98168, Messina, Italy
| | - Rossella Panarese
- Dipartimento di Medicina Veterinaria, Università di Bari, 70010, Valenzano, Bari, Italy
| | - Emanuele Brianti
- Dipartimento di Scienze Veterinarie, Università di Messina, 98168, Messina, Italy
| | - Domenico Otranto
- Dipartimento di Medicina Veterinaria, Università di Bari, 70010, Valenzano, Bari, Italy.
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Widagdo W, Sooksawasdi Na Ayudhya S, Hundie GB, Haagmans BL. Host Determinants of MERS-CoV Transmission and Pathogenesis. Viruses 2019; 11:E280. [PMID: 30893947 PMCID: PMC6466079 DOI: 10.3390/v11030280] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 01/01/2023] Open
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic pathogen that causes respiratory infection in humans, ranging from asymptomatic to severe pneumonia. In dromedary camels, the virus only causes a mild infection but it spreads efficiently between animals. Differences in the behavior of the virus observed between individuals, as well as between humans and dromedary camels, highlight the role of host factors in MERS-CoV pathogenesis and transmission. One of these host factors, the MERS-CoV receptor dipeptidyl peptidase-4 (DPP4), may be a critical determinant because it is variably expressed in MERS-CoV-susceptible species as well as in humans. This could partially explain inter- and intraspecies differences in the tropism, pathogenesis, and transmissibility of MERS-CoV. In this review, we explore the role of DPP4 and other host factors in MERS-CoV transmission and pathogenesis-such as sialic acids, host proteases, and interferons. Further characterization of these host determinants may potentially offer novel insights to develop intervention strategies to tackle ongoing outbreaks.
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Affiliation(s)
- W Widagdo
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
| | | | - Gadissa B Hundie
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Bart L Haagmans
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
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40
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Chen D, Xiao Y, Tang S. Air quality index induced nonsmooth system for respiratory infection. J Theor Biol 2019; 460:160-169. [PMID: 30312690 DOI: 10.1016/j.jtbi.2018.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/31/2018] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 11/17/2022]
Abstract
It has been observed that air pollution greatly affects respiratory infection and generates public health problem, but there are many challenges to quantifying the dynamics of air pollution and evaluating its impact on respiratory infections. A periodic Filippov system describing the state-dependent control strategy for air pollution, described by air quality index (AQI), is proposed. We theoretically analyze the non-autonomous Filippov subsystem for variation of AQI by converting into an autonomous Filippov system via increasing dimension of the system. We obtain that there is a unique periodic solution which is globally asymptotically stable. In particular, it shows that AQI stabilizes at either one of the periodic solutions of the free and control systems or a new periodic solution induced by the on-off control strategies, depending on the threshold levels. Then, a periodic system for respiratory infection with AQI-embedded transmission probability is formulated to examine the influence of air pollution on respiratory infection. We further obtain the control reproduction number (basic reproduction number with control strategies) of this periodic respiratory infection model. It is shown that the respiratory infection will go extinct if the control reproduction number is less than unity, while uniformly persists for larger than unity. The case study showed that the estimated threshold level coincides with the actual threshold which launches the traffic limitation measure in Xi'an, indicating the untimely density-dependent traffic limitation measure was ineffective in improving air quality. Numerically studies indicate that increasing the threshold level leads to an increase in the maximum value of the unique periodic solution for AQI and the control reproduction number for the AQI embedded SEIS model. These findings emphasize the importance of suitable threshold level to trigger interventions and suggest that untimely implementing control strategy may not effectively control air population.
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Affiliation(s)
- Daipeng Chen
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an 710049, PR China
| | - Yanni Xiao
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an 710049, PR China.
| | - Sanyi Tang
- College of Mathematics and Information Science, Shaanxi Normal University, Xi'an 710062, PR China
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41
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Jain M, Sharma A, Sen MK, Rani V, Gaind R, Suri JC. Phenotypic and molecular characterization of Acinetobacter baumannii isolates causing lower respiratory infections among ICU patients. Microb Pathog 2018; 128:75-81. [PMID: 30562602 DOI: 10.1016/j.micpath.2018.12.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 08/22/2018] [Revised: 11/16/2018] [Accepted: 12/11/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multi-drug resistant Acinetobacter baumannii has emerged as important nosocomial pathogen associated with various infections including lower respiratory tract. Limited therapeutic options contribute to increased morbidity and mortality. Acinetobacter baumannii has the ability to persist in the environment for prolonged periods. Breach in infection control practices increases the chances of cross transmission between patients and inter/intraspecies transmission of resistance elements. The present prospective work was conducted among patients with lower respiratory tract infections (LRTI) in the intensive care unit (ICU) to study the etiology with special reference to Acinetobacter baumannii and the role of immediate patient environment in the ICU as possible source of infection. Acinetobacter baumannii were characterized for antimicrobial susceptibility, mechanism of carbapenem resistance and virulence determinants. Molecular typing of the clinical and environmental isolates was undertaken to study the probable modes of transmission. MATERIALS AND METHODS Appropriate respiratory samples from 107 patients with LRTI admitted to ICU during September 2016 to March 2017 were studied for likely bacterial pathogens. Environmental samples (n = 71) were also screened. All the samples were processed using conventional microbiological methods. Consecutive Acinetobacter spp. isolated from clinical and environmental (health care workers and environment from ICU) samples were included in the study. Antimicrobial susceptibility was performed as per CLSI guidelines. Carbapenem resistance, mediated by carbapenemase genes (blaOXA-23-like,blaOXA-24-like,blaOXA-58-like and blaNDM-1) were studied by PCR. Biofilm forming ability was tested phenotypically using microtitre plate method. Pulse Field Gel Electrophoresis (PFGE) was used to study clonality of the clinical and environmental isolates. RESULTS The prevalence of Acinetobacter baumannii was 26.2% (28/107) and 11.26% (8/71) among patients with LRTI and environmental samples respectively. The carbapenem resistance was high, 96.42% (27/28) and 87.5% (7/8) in clinical and environmental isolates respectively. The most common carbapenemase associated with resistance was blaOXA-23-like gene followed by blaNDM-1 among both the clinical and environmental isolates. All isolates were sensitive to colistin (MIC ≤ 1 μg/ml). Biofilm production was observed among all clinical (n = 28) and 87.5% (7/8) of the environmental isolates. Line listing of the cases suggests the occurrence of infections throughout the study period with no significant clustering. On PFGE, 12 clusters were observed and 16/36 isolates were present in one single cluster that included both clinical and environmental isolates which were either carbapenem resistant or sensitive. DISCUSSION Carbapenem resistant Acinetobacter baumannii (CRAB) is an important cause of LRTI in the ICU. PFGE suggests spread of carbapenem resistant isolates via cross transmission among patients and the environment. The detection of blaNDM-1 gene among Acinetobacter baumannii and existence of carbapenem resistant and sensitive isolates within the same clones suggests horizontal transmission of resistant genes among various bacterial species. The ability of Acinetobacter baumannii to form biofilms may contribute to its persistence in the environment. This along with breach in infection control practices are the likely factors contributing to this transmission. This information can be used to strengthen and monitor infection control (IC) and the hospital cleaning and disinfection practices to prevent spread of resistant organisms within the ICU. Colistin remains drug of choice for management of CRAB.
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Affiliation(s)
- Manisha Jain
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Amit Sharma
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - M K Sen
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Vandana Rani
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Rajni Gaind
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India.
| | - J C Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
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Ikonen N, Savolainen-Kopra C, Enstone JE, Kulmala I, Pasanen P, Salmela A, Salo S, Nguyen-Van-Tam JS, Ruutu P. Deposition of respiratory virus pathogens on frequently touched surfaces at airports. BMC Infect Dis 2018; 18:437. [PMID: 30157776 PMCID: PMC6116441 DOI: 10.1186/s12879-018-3150-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 03/07/2018] [Accepted: 05/15/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND International and national travelling has made the rapid spread of infectious diseases possible. Little information is available on the role of major traffic hubs, such as airports, in the transmission of respiratory infections, including seasonal influenza and a pandemic threat. We investigated the presence of respiratory viruses in the passenger environment of a major airport in order to identify risk points and guide measures to minimize transmission. METHODS Surface and air samples were collected weekly at three different time points during the peak period of seasonal influenza in 2015-16 in Finland. Swabs from surface samples, and air samples were tested by real-time PCR for influenza A and B viruses, respiratory syncytial virus, adenovirus, rhinovirus and coronaviruses (229E, HKU1, NL63 and OC43). RESULTS Nucleic acid of at least one respiratory virus was detected in 9 out of 90 (10%) surface samples, including: a plastic toy dog in the children's playground (2/3 swabs, 67%); hand-carried luggage trays at the security check area (4/8, 50%); the buttons of the payment terminal at the pharmacy (1/2, 50%); the handrails of stairs (1/7, 14%); and the passenger side desk and divider glass at a passport control point (1/3, 33%). Among the 10 respiratory virus findings at various sites, the viruses identified were: rhinovirus (4/10, 40%, from surfaces); coronavirus (3/10, 30%, from surfaces); adenovirus (2/10, 20%, 1 air sample, 1 surface sample); influenza A (1/10, 10%, surface sample). CONCLUSIONS Detection of pathogen viral nucleic acids indicates respiratory viral surface contamination at multiple sites associated with high touch rates, and suggests a potential risk in the identified airport sites. Of the surfaces tested, plastic security screening trays appeared to pose the highest potential risk, and handling these is almost inevitable for all embarking passengers.
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Affiliation(s)
- Niina Ikonen
- Department of Health Security, National Institute for Health and Welfare, P.O.Box 30, 00271 Helsinki, Finland
| | - Carita Savolainen-Kopra
- Department of Health Security, National Institute for Health and Welfare, P.O.Box 30, 00271 Helsinki, Finland
| | - Joanne E. Enstone
- School of Medicine, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Ilpo Kulmala
- VTT Technical Research Centre of Finland Ltd, Espoo and Tampere, Finland
| | - Pertti Pasanen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anniina Salmela
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Satu Salo
- VTT Technical Research Centre of Finland Ltd, Espoo and Tampere, Finland
| | - Jonathan S. Nguyen-Van-Tam
- School of Medicine, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Petri Ruutu
- Department of Health Security, National Institute for Health and Welfare, P.O.Box 30, 00271 Helsinki, Finland
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Borkenhagen LK, Mallinson KA, Tsao RW, Ha SJ, Lim WH, Toh TH, Anderson BD, Fieldhouse JK, Philo SE, Chong KS, Lindsley WG, Ramirez A, Lowe JF, Coleman KK, Gray GC. Surveillance for respiratory and diarrheal pathogens at the human-pig interface in Sarawak, Malaysia. PLoS One 2018; 13:e0201295. [PMID: 30052648 PMCID: PMC6063427 DOI: 10.1371/journal.pone.0201295] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 03/15/2018] [Accepted: 07/12/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The large livestock operations and dense human population of Southeast Asia are considered a hot-spot for emerging viruses. OBJECTIVES To determine if the pathogens adenovirus (ADV), coronavirus (CoV), encephalomyocarditis virus (EMCV), enterovirus (EV), influenza A-D (IAV, IBV, ICV, and IDV), porcine circovirus 2 (PCV2), and porcine rotaviruses A and C (RVA and RVC), are aerosolized at the animal-interface, and if humans working in these environments are carrying these viruses in their nasal airways. STUDY This cross-sectional study took place in Sarawak, Malaysia among 11 pig farms, 2 abattoirs, and 3 animal markets in June and July of 2017. Pig feces, pig oral secretions, bioaerosols, and worker nasal wash samples were collected and analyzed via rPCR and rRT-PCR for respiratory and diarrheal viruses. RESULTS In all, 55 pig fecal, 49 pig oral or water, 45 bioaerosol, and 78 worker nasal wash samples were collected across 16 sites. PCV2 was detected in 21 pig fecal, 43 pig oral or water, 3 bioaerosol, and 4 worker nasal wash samples. In addition, one or more bioaerosol or pig samples were positive for EV, IAV, and RVC, and one or more worker samples were positive for ADV, CoV, IBV, and IDV. CONCLUSIONS This study demonstrates that nucleic acids from a number of targeted viruses were present in pig oral secretions and pig fecal samples, and that several viruses were detected in bioaerosol samples or in the nasal passages of humans with occupational exposure to pigs. These results demonstrate the need for future research in strengthening viral surveillance at the human-animal interface, specifically through expanded bioaerosol sampling efforts and a seroepidemiological study of individuals with exposure to pigs in this region for PCV2 infection.
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Affiliation(s)
- Laura K. Borkenhagen
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Infectious Disease, School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Kerry A. Mallinson
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Rick W. Tsao
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Siaw-Jing Ha
- SEGi University Sibu Clinical Campus, Sibu, Sarawak, Malaysia
- Department of Paediatrics, Sibu Hospital, Sibu, Sarawak, Malaysia
| | - Wei-Honn Lim
- Clinical Research Center, Sibu Hospital, Sibu, Sarawak, Malaysia
| | - Teck-Hock Toh
- SEGi University Sibu Clinical Campus, Sibu, Sarawak, Malaysia
- Department of Paediatrics, Sibu Hospital, Sibu, Sarawak, Malaysia
- Clinical Research Center, Sibu Hospital, Sibu, Sarawak, Malaysia
| | - Benjamin D. Anderson
- Division of Infectious Disease, School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Jane K. Fieldhouse
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Infectious Disease, School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Sarah E. Philo
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Infectious Disease, School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Kuek-Sen Chong
- SEGi University Sibu Clinical Campus, Sibu, Sarawak, Malaysia
- Divisional Health Office, Sibu, Sarawak, Malaysia
| | - William G. Lindsley
- National Institute for Occupational Safety and Health, Morgantown, West Virginia, United States of America
| | - Alejandro Ramirez
- Department of Veterinary Diagnostics and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa, United States of America
| | - James F. Lowe
- Integrated Food Animal Management Systems, Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | | | - Gregory C. Gray
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Infectious Disease, School of Medicine, Duke University, Durham, North Carolina, United States of America
- Duke-NUS Medical School, Singapore, Singapore
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Affiliation(s)
- Nicolás Cifuentes-Muñoz
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
| | - Rebecca Ellis Dutch
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
- * E-mail: (RED); (RC)
| | - Roberto Cattaneo
- Department of Molecular Medicine and Virology and Gene Therapy Graduate School Track, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail: (RED); (RC)
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Schlinkmann KM, Bakuli A, Karch A, Meyer F, Dreesman J, Monazahian M, Mikolajczyk R. Transmission of respiratory and gastrointestinal infections in German households with children attending child care. Epidemiol Infect 2018; 146:627-632. [PMID: 29478420 PMCID: PMC9134537 DOI: 10.1017/s0950268818000316] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/25/2017] [Accepted: 01/30/2018] [Indexed: 11/06/2022] Open
Abstract
Transmission of acute respiratory infections (ARI) and acute gastroenteritis (AGE) often occurs in households. The aim of this study was to assess which proportion of ARI and AGE is introduced and transmitted by children in German households with children attending child care. We recruited families with children aged 0-6 years in Braunschweig (Germany), for a 4 months prospective cohort study in the winter period 2014/2015. Every household member was included in a health diary and used nasal swabs for pathogen identification in case of ARI. We defined a transmission if two persons had overlapping periods with symptoms and used additional definitions for sensitivity analyses. In total, 77 households participated with 282 persons. We observed 277 transmission events for ARI and 23 for AGE. In most cases, the first infected person in a household was a child (ARI: 63%, AGE: 53%), and the risk of within-household transmission was two times higher when the index case was a child. In 26 ARI-transmission events, pathogens were detected for both cases; hereof in 35% (95% confidence interval (17-56%)) the pathogens were different. Thus, symptomatic infections in household members, apparently linked in time, were in 2/3 associated with the same pathogens.
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Affiliation(s)
- K. M. Schlinkmann
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- PhD Programme Epidemiology, Hannover Medical School, Braunschweig-Hannover, Germany
| | - A. Bakuli
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- PhD Programme Epidemiology, Hannover Medical School, Braunschweig-Hannover, Germany
| | - A. Karch
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - F. Meyer
- Helmholtz Centre for Infection Research, KOM – Microbial Communication, Braunschweig, Germany
| | - J. Dreesman
- Governmental Institute of Public Health of Lower Saxony, Hannover, Germany
| | - M. Monazahian
- Governmental Institute of Public Health of Lower Saxony, Hannover, Germany
| | - R. Mikolajczyk
- Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Braunschweig-Hannover, Germany
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Halle (Saale), Germany
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Abstract
Health officials lack field-implementable tools for forecasting the effects that
a large-scale release of Bacillus anthracis spores would have
on public health and hospitals. We created a modeling tool (combining
inhalational anthrax caseload projections based on initial case reports, effects
of variable postexposure prophylaxis campaigns, and healthcare facility surge
capacity requirements) to project hospitalizations and casualties from a newly
detected inhalation anthrax event, and we examined the consequences of
intervention choices. With only 3 days of case counts, the model can predict
final attack sizes for simulated Sverdlovsk-like events (1979 USSR) with
sufficient accuracy for decision making and confirms the value of early
postexposure prophylaxis initiation. According to a baseline scenario, hospital
treatment volume peaks 15 days after exposure, deaths peak earlier (day 5), and
recovery peaks later (day 23). This tool gives public health, hospital, and
emergency planners scenario-specific information for developing quantitative
response plans for this threat.
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EMERGING RESPIRATORY DISEASE - INFLUENZA INFLUENZA VIRUS OVERVIEW. Dis Mon 2017; 63:248-51. [PMID: 29737281 DOI: 10.1016/j.disamonth.2017.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
MESH Headings
- Animals
- Antiviral Agents/therapeutic use
- Birds
- Communicable Diseases, Emerging/physiopathology
- Communicable Diseases, Emerging/therapy
- Communicable Diseases, Emerging/transmission
- Communicable Diseases, Emerging/virology
- Humans
- Influenza A Virus, H7N2 Subtype
- Influenza A Virus, H7N9 Subtype
- Influenza A Virus, H9N2 Subtype
- Influenza in Birds/transmission
- Influenza in Birds/virology
- Influenza, Human/physiopathology
- Influenza, Human/therapy
- Influenza, Human/transmission
- Influenza, Human/virology
- Respiratory Tract Infections/physiopathology
- Respiratory Tract Infections/therapy
- Respiratory Tract Infections/transmission
- Respiratory Tract Infections/virology
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SELECTED EPIDEMICS & EMERGING PATHOGENS - RESPIRATORY ILLNESSES - AN OVERVIEW. Dis Mon 2017; 63:246-8. [PMID: 29737280 DOI: 10.1016/j.disamonth.2017.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Asfaw A, Rosa R, Pana-Cryan R. Potential Economic Benefits of Paid Sick Leave in Reducing Absenteeism Related to the Spread of Influenza-Like Illness. J Occup Environ Med 2017; 59:822-829. [PMID: 28692009 PMCID: PMC5649342 DOI: 10.1097/jom.0000000000001076] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 11/26/2022]
Abstract
OBJECTIVE Most U.S. employers are not required to provide paid sick leave (PSL), and there is limited information on the economic return of providing PSL. We estimated potential benefits to employers of PSL in reducing absenteeism related to the spread of influenza-like illness (ILI). METHODS We used nationally representative data and a negative binomial random effects model to estimate the impact of PSL in reducing overall absence due to illness or injury. We used published data to compute the share of ILI from the total days of absence, ILI transmission rates at workplaces, wages, and other parameters. RESULTS Providing PSL could have saved employers $0.63 to $1.88 billion in reduced ILI-related absenteeism costs per year during 2007 to 2014 in 2016 dollars. CONCLUSION These findings might help employers consider PSL as an investment rather than as a cost without any return.
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Affiliation(s)
- Abay Asfaw
- Centers for Disease Control and Prevention (CDC) - National Institute for Occupational Safety and Health (NIOSH), Office of the Director, Economics Research and Support Office, Washington, District of Columbia (Drs Asfaw, Pana-Cryan), and Centers for Disease Control and Prevention (CDC) - National Institute for Occupational Safety and Health (NIOSH), Office of the Director, Washington, District of Columbia (Dr Rosa)
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Abstract
The spread of many respiratory infections is determined by contact patterns between infectious and susceptible individuals in the population. There are no published data for quantifying social contact patterns relevant to the spread of respiratory infectious diseases in Hong Kong which is a hotspot for emerging infectious diseases due to its high population density and connectivity in the air transportation network. We adopted a commonly used diary-based design to conduct a social contact survey in Hong Kong in 2015/16 using both paper and online questionnaires. Participants using paper questionnaires reported more contacts and longer contact duration than those using online questionnaires. Participants reported 13 person-hours of contact and 8 contacts per day on average, which decreased over age but increased with household size, years of education and income level. Prolonged and frequent contacts, and contacts at home, school and work were more likely to involve physical contacts. Strong age-assortativity was observed in all age groups. We evaluated the characteristics of social contact patterns relevant to the spread of respiratory infectious diseases in Hong Kong. Our findings could help to improve the design of future social contact surveys, parameterize transmission models of respiratory infectious diseases, and inform intervention strategies based on model outputs.
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Affiliation(s)
- Kathy 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 SAR, People's Republic of China
| | - Mark Jit
- 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 SAR, People's Republic of China
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Modelling and Economics Unit, Public Health England, London, United Kingdom
| | - Eric H Y Lau
- 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 SAR, People's Republic of China
| | - Joseph T Wu
- 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 SAR, People's Republic of China.
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