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Probable transmission routes of the influenza virus in a nosocomial outbreak

  • S. Xiao (a1), J. W. Tang (a2) (a3), D. S. Hui (a4), H. Lei (a1) (a5), H. Yu (a1) and Y. Li (a1)...

Abstract

Influenza is a long-standing public health concern, but its transmission remains poorly understood. To have a better knowledge of influenza transmission, we carried out a detailed modelling investigation in a nosocomial influenza outbreak in Hong Kong. We identified three hypothesised transmission modes between index patient and other inpatients based on the long-range airborne and fomite routes. We considered three kinds of healthcare workers’ routine round pathways in 1140 scenarios with various values of important parameters. In each scenario, we used a multi-agent modelling framework to estimate the infection risk for each hypothesis and conducted least-squares fitting to evaluate the hypotheses by comparing the distribution of the infection risk with that of the attack rates. Amongst the hypotheses tested in the 1140 scenarios, the prediction of modes involving the long-range airborne route fit better with the attack rates, and that of the two-route transmission mode had the best fit, with the long-range airborne route contributing about 94% and the fomite route contributing 6% to the infections. Under the assumed conditions, the influenza virus was likely to have spread via a combined long-range airborne and fomite routes, with the former predominant and the latter negligible.

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Copyright

Corresponding author

Author for correspondence: S. Xiao, E-mail: u3002980@hku.hk

References

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1.Monto, AS (1987) Influenza: quantifying morbidity and mortality. The American Journal of Medicine 82, 2025.
2.Potter, CW (2001) A history of influenza. Journal of Applied Microbiology 91, 572579.
3.World Health Organization (2005) Ten things you need to know about pandemic influenza (update of 14 October 2005). The Weekly Epidemiological Record 80, 428431.
4.Dawood, FS, et al. (2012) Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus circulation: a modelling study. The Lancet Infectious Diseases 12, 687695.
5.Fact sheet on seasonal influenza. Available at http://www.who.int/mediacentre/factsheets/fs211/en/ (Accessed 20 August 2017).
6.70 years of influenza control. Available at http://www.who.int/influenza/gip-anniversary/en/ (Accessed 23 August 2017).
7.Brankston, G, et al. (2007) Transmission of influenza A in human beings. The Lancet Infectious Diseases 7, 257265.
8.Killingley, B and Nguyen-Van-Tam, J (2013) Routes of influenza transmission. Influenza and Other Respiratory Viruses 7, 4251.
9.Tellier, R (2006) Review of aerosol transmission of influenza A virus. Emerging Infectious Diseases 12, 16571662.
10.Weber, TP and Stilianakis, NI (2008) Inactivation of influenza A viruses in the environment and modes of transmission: a critical review. Journal of Infection 57, 361373.
11.Prevention strategies for seasonal influenza in healthcare settings: guidelines and recommendations. Available at https://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm (Accessed 23 August 2017).
12.Zhang, N, et al. (2016) Dynamic population flow based risk analysis of infectious disease propagation in a metropolis. Environment International 94, 369379.
13.Wong, BCK, et al. (2010) Possible role of aerosol transmission in a hospital outbreak of influenza. Clinical Infectious Diseases 51, 11761183.
14.Xiao, S, et al. (2017) Role of fomites in SARS transmission during the largest hospital outbreak in Hong Kong. PLoS ONE 12, e0181558.
15.Xiao, S, et al. (2018) A study of probable transmission routes of MERS-CoV in the first hospital outbreak in the Republic of Korea. Indoor Air 28, 5163.
16.Li, Y, Delsante, A and Symons, J (2000) Prediction of natural ventilation in buildings with large openings. Build and Environment 35, 191206.
17.Li, Y, et al. (2005) Multi-zone modeling of probable SARS virus transmission by airflow between flats in Block E, Amoy Gardens. Indoor Air 15, 96111.
18.Xiao, S, Tang, JW and Li, Y (2017) Airborne or fomite transmission for norovirus? A case study revisited. International Journal of Environmental Research and Public Health 14, 1571.
19.Nicas, M and Jones, RM (2009) Relative contributions of four exposure pathways to influenza infection risk. Risk Analysis 29, 12921303.
20.Zhang, N, et al. (2018) A human behavior integrated hierarchical model of airborne disease transmission in a large city. Building and Environment 127, 211220.
21.Johnson, JB and Omland, KS (2004) Model selection in ecology and evolution. Trends in Ecology & Evolution 19, 101108.
22.Draper, NR, Smith, H and Pownell, E (1966) Applied Regression Analysis. New York: Wiley.
23.Chen, C, et al. (2011) Role of two-way airflow owing to temperature difference in severe acute respiratory syndrome transmission: revisiting the largest nosocomial severe acute respiratory syndrome outbreak in Hong Kong. Journal of the Royal Society Interface 8, 699710.
24.Qian, H, et al. (2009) Spatial distribution of infection risk of SARS transmission in a hospital ward. Building and Environment 44, 16511658.
25.Tang, JW, et al. (2014) Absence of detectable influenza RNA transmitted via aerosol during various human respiratory activities – experiments from Singapore and Hong Kong. PLoS ONE 9, e107338.
26.Endo, T, et al. (2010) Reflectometric detection of influenza virus in human saliva using nanoimprint lithography-based flexible two-dimensional photonic crystal biosensor. Sensors and Actuators B: Chemical 148, 269276.
27.Johnson, G, et al. (2011) Modality of human expired aerosol size distributions. Journal of Aerosol Science 42, 839851.
28.Yan, J, et al. (2018) Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community. Proceedings of the National Academy of Sciences of the United States of America 115, 10811086 .
29.Murphy, BR, et al. (1973) Temperature-sensitive mutants of influenza virus. III. Further characterization of the ts-1 [E] influenza A recombinant (H3N2) virus in man. Journal of Infectious Diseases 128, 479487.
30.Spicknall, IH, et al. (2010) Informing optimal environmental influenza interventions: how the host, agent, and environment alter dominant routes of transmission. PLoS Computational Biology 6, e1000969.
31.Blachere, FM, et al. (2009) Measurement of airborne influenza virus in a hospital emergency department. Clinical Infectious Diseases 48, 438440.
32.Yang, W, Elankumaran, S and Marr, LC (2011) Concentrations and size distributions of airborne influenza A viruses measured indoors at a health centre, a day-care centre and on aeroplanes. Journal of the Royal Society Interface 8, 11761184.
33.Boone, SA and Gerba, CP (2005) The occurrence of influenza A virus on household and day care center fomites. Journal of Infection 51, 103109.
34.Simmerman, JM, et al. (2010) Influenza A virus contamination of common household surfaces during the 2009 influenza A (H1N1) pandemic in Bangkok, Thailand: implications for contact transmission. Clinical Infectious Diseases 51, 10531061.
35.Loosli, C, et al. (1943) Experimental air-borne influenza infection. I. Influence of humidity on survival of virus in air. Proceedings of the Society for Experimental Biology and Medicine 53, 205206.
36.Schaffer, F, Soergel, M and Straube, D (1976) Survival of airborne influenza virus: effects of propagating host, relative humidity, and composition of spray fluids. Archives of Virology 51, 263273.
37.Bean, B, et al. (1982) Survival of influenza viruses on environmental surfaces. The Journal of Infectious Diseases 146, 4751.
38.Noyce, J, Michels, H and Keevil, C (2007) Inactivation of influenza A virus on copper versus stainless steel surfaces. Applied and Environmental Microbiology 73, 27482750.
39.McClean, R (1961) The effect of ultraviolet radiation upon the transmission of epidemic influenza in long-term hospital patients. The American Review of Respiratory Disease 83, 3638.
40.Moser, MR, et al. (1979) An outbreak of influenza aboard a commercial airliner. American Journal of Epidemiology 110, 16.
41.Drinka, PJ, et al. (1996) Report of an outbreak: nursing home architecture and influenza-A attack rates. Journal of the American Geriatrics Society 44, 910913.
42.Atkinson, MP and Wein, LM (2008) Quantifying the routes of transmission for pandemic influenza. Bulletin of Mathematical Biology 70, 820867.
43.Lei, H, et al. (2018) Route of transmission of influenza A H1N1, SARS CoV and norovirus in air cabins – a comparative analysis. Indoor Air 28, 394403.
44.Hui, DS, et al. (2006) Noninvasive positive-pressure ventilation: an experimental model to assess air and particle dispersion. Chest 130, 730740.
45.Hui, DS, et al. (2009) Exhaled air and aerosolized droplet dispersion during application of a jet nebulizer. Chest 135, 648654.
46.Hui, DS, et al. (2009) Exhaled air dispersion distances during noninvasive ventilation via different respironics face masks. Chest 136, 9981005.
47.Wolff, MH, et al. (2005) Environmental survival and microbicide inactivation of coronaviruses. In Schmidt, A, Wolff, MH and Weber, O (eds), Coronaviruses with Special Emphasis on First Insights Concerning SARS. Basel: Birkhäuser, pp. 201212.
48.Baker, MG, et al. (2010) Transmission of pandemic A/H1N1 2009 influenza on passenger aircraft: retrospective cohort study. BMJ 340, c2424.
49.Stehlé, J, et al. (2011) High-resolution measurements of face-to-face contact patterns in a primary school. PLoS ONE 6, e23176.
50.Voirin, N, et al. (2015) Combining high-resolution contact data with virological data to investigate influenza transmission in a tertiary care hospital. Infection Control & Hospital Epidemiology 36, 254260.
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