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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.; Read, Robert; Hayward, Andrew; Lim, Wei Shen; Curran, Martin D.; Nicholson, Karl G.; Nguyen-Van-Tam, Jonathan S.

Authors

Benjamin Killingley

Ben Killingley ben.killingley@nhs.net

Jane Greatorex

Paul Digard

Helen Wise

Fayna Garcia

Harsha Varsani

Simon Cauchemez

Joanne E. Enstone joanne.enstone@nottingham.ac.uk

Robert Read C.M.Phillips@soton.ac.uk

Andrew Hayward

Wei Shen Lim weishen.lim@nuh.nhs.uk

Martin D. Curran

Karl G. Nicholson

Jonathan S. Nguyen-Van-Tam Jonathan.Van-Tam@nottingham.ac.uk



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.

Journal Article Type Article
Publication Date 2016-05
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
APA6 Citation Lim, W. S., Read, R. C., Killingley, B., Killingley, B., Greatorex, J., Digard, P., …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
DOI https://doi.org/10.1016/j.jiph.2015.10.009
Keywords Influenza; Environmental; Deposition; Infection; Control
Publisher URL http://www.sciencedirect.com/science/article/pii/S1876034115001926
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0
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.

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0


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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0





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