The environmental deposition of influenza virus from patients infected with influenza A(H1N1)pdm09: Implications for infection prevention and control

Killingley, Benjamin; Killingley, Ben; Greatorex, Jane; Digard, Paul; Wise, Helen; Garcia, Fayna; Varsani, Harsha; Cauchemez, Simon; Enstone, Joanne E.; Hayward, Andrew; Curran, Martin D.; Read, Robert; Lim, Wei Shen; Nicholson, Karl G.; Nguyen-Van-Tam, Jonathan S.

Abstract

In a multi-center, prospective, observational study over two influenza seasons, we sought to quantify and correlate the amount of virus recovered from the nares of infected subjects with that recovered from their immediate environment in community and hospital settings. We recorded the symptoms of adults and children with A(H1N1)pdm09 infection, took nasal swabs, and sampled touched surfaces and room air. Forty-two infected subjects were followed up. The mean duration of virus shedding was 6.2 days by PCR (Polymerase Chain Reaction) and 4.2 days by culture. Surface swabs were collected from 39 settings; 16 (41%) subject locations were contaminated with virus. Overall, 33 of the 671 (4.9%) surface swabs were PCR positive for influenza, of which two (0.3%) yielded viable virus. On illness Day 3, subjects yielding positive surface samples had significantly higher nasal viral loads (geometric mean ratio 25.7; 95% CI 1.75, 376.0, p=0.021) and a positive correlation (r=0.47, p=0.006) was observed between subject nasal viral loads and viral loads recovered from the surfaces around them. Room air was sampled in the vicinity of 12 subjects, and PCR positive samples were obtained for five (42%) samples. Influenza virus shed by infected subjects did not detectably contaminate the vast majority of surfaces sampled. We question the relative importance of the indirect contact transmission of influenza via surfaces, though our data support the existence of super-spreaders via this route. The air sampling results add to the accumulating evidence that supports the potential for droplet nuclei (aerosol) transmission of influenza.

Citation

Killingley, B., Killingley, B., Greatorex, J., Digard, P., Wise, H., Garcia, F., Varsani, H., Cauchemez, S., Enstone, J. E., Hayward, A., Curran, M. D., Read, R., Lim, W. S., Nicholson, K. G., & Nguyen-Van-Tam, J. S. (2016). The environmental deposition of influenza virus from patients infected with influenza A(H1N1)pdm09: Implications for infection prevention and control. Journal of Infection and Public Health, 9(3), 278-288. https://doi.org/10.1016/j.jiph.2015.10.009

• Journal Article Type: Article
• Acceptance Date: Oct 7, 2015
• Online Publication Date: Dec 2, 2015
• Publication Date: 2016-05
• Deposit Date: Mar 14, 2016
• Publicly Available Date: Mar 14, 2016
• Journal: Journal of Infection and Public Health
• Print ISSN: 1876-0341
• Electronic ISSN: 1876-035X
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 3
• Pages: 278-288
• DOI: https://doi.org/10.1016/j.jiph.2015.10.009
• Keywords: Influenza; Environmental; Deposition; Infection; Control
• Public URL: https://nottingham-repository.worktribe.com/output/988541
• Publisher URL: http://www.sciencedirect.com/science/article/pii/S1876034115001926
• Additional Information: This article is maintained by: Elsevier; Article Title: The environmental deposition of influenza virus from patients infected with influenza A(H1N1)pdm09: Implications for infection prevention and control; Journal Title: Journal of Infection and Public Health; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jiph.2015.10.009; Content Type: article; Copyright: © 2015 King Saud Bin Abdulaziz University for Health Sciences. Production and hosting by Elsevier Limited.