Evidence of Respiratory Syncytial Virus Spread by Aerosol. Time to Revisit Infection Control Strategies?

Kulkarni, Hemant; Smith, Claire M.; Lee, Dani Do Hyang; Hirst, Robert A.; Easton, Andrew J.; O’Callaghan, Chris

doi:10.1164/rccm.201509-1833oc

Cited by 123 publications

(105 citation statements)

References 28 publications

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“…The mean total bioaerosol concentrations in the different areas of the hospitals were highest in the inpatient facilities (77 CFU/m 3 , 95% confidence interval (CI), 55-108) compared with the restricted (4 CFU/m 3 , 95% CI, [10][11][12][13][14][15] and public areas (14 CFU/m 3 , 95% CI, [10][11][12][13][14][15][16][17][18][19]. Hospital areas with natural ventilation had the highest total bioaerosol concentrations (201 CFU/m 3 , 95% CI, 135-300) compared with areas using conventional mechanical ventilation systems (20 CFU/m 3 , 95% CI, [16][17][18][19][20][21][22][23][24]. Hospital areas using sophisticated mechanical ventilation systems (such as increased air changes per hour, directional flow and filtration systems) had the lowest total bioaerosol concentrations (9 CFU/m 3 , 95% CI, 7-13).…”

Section: Resultsmentioning

confidence: 99%

Indoor hospital air and the impact of ventilation on bioaerosols: a systematic review

Stockwell

Ballard

O’Rourke

et al. 2019

Journal of Hospital Infection

116

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Section: Resultsmentioning

confidence: 99%

Indoor hospital air and the impact of ventilation on bioaerosols: a systematic review

Stockwell

Ballard

O’Rourke

et al. 2019

Journal of Hospital Infection

116

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“…The available evidence about the airborne spread of infection is limited, although transmission has been described for tuberculosis, measles, chickenpox and pertussis and multidrug-resistant nontuberculous mycobacterium (Leclair et al, 1980;Bloch et al, 1985;Dharmadhikari et al, 2012;Warfel et al, 2012;Bryant et al, 2016). Other studies have suggested opportunistic spread of influenza virus and respiratory syncytial virus (RSV) via an airborne route (Roy and Milton, 2004;Killingley and Nguyen-Van-Tam, 2013;Luongo et al, 2016;Kulkarni et al, 2016). Further, Zingg et al (2015) and Arefian et al (2016) pointed out to the possibility of poor indoor air quality resulting in increased morbidity for health care workers, extended patient hospitalization as a result of hospital-acquired illnesses and also to increased economic costs.…”

Section: Introductionmentioning

confidence: 99%

Particle and bioaerosol characteristics in a paediatric intensive care unit

Mackay

Ramsay

et al. 2017

Environment International

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The paediatric intensive care unit (PICU) provides care to critically ill neonates, infants and children. These patients are vulnerable and susceptible to the environment surrounding them, yet there is little information available on indoor air quality and factors affecting it within a PICU. To address this gap in knowledge we conducted continuous indoor and outdoor airborne particle concentration measurements over a two-week period at the Royal Children's Hospital PICU in Brisbane, Australia, and we also collected 82 bioaerosol samples to test for the presence of bacterial and viral pathogens. Our results showed that both 24-hour average indoor particle mass (PM) (0.6-2.2μgm, median: 0.9μgm) and submicrometer particle number (PN) (0.1-2.8×10pcm, median: 0.67×10pcm) concentrations were significantly lower (p<0.01) than the outdoor concentrations (6.7-10.2μgm, median: 8.0μgm for PM and 12.1-22.2×10pcm, median: 16.4×10pcm for PN). In general, we found that indoor particle concentrations in the PICU were mainly affected by indoor particle sources, with outdoor particles providing a negligible background. We identified strong indoor particle sources in the PICU, which occasionally increased indoor PN and PM concentrations from 0.1×10 to 100×10pcm, and from 2μgm to 70μgm, respectively. The most substantial indoor particle sources were nebulization therapy, tracheal suction and cleaning activities. The average PM and PN emission rates of nebulization therapy ranged from 1.29 to 7.41mgmin and from 1.20 to 3.96pmin×10, respectively. Based on multipoint measurement data, it was found that particles generated at each location could be quickly transported to other locations, even when originating from isolated single-bed rooms. The most commonly isolated bacterial genera from both primary and broth cultures were skin commensals while viruses were rarely identified. Based on the findings from the study, we developed a set of practical recommendations for PICU design, as well as for medical and cleaning staff to mitigate aerosol generation and transmission to minimize infection risk to PICU patients.

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“…Respiratory syncytial virus is an important viral pathogen not only in children, but also in immune-compromised patients, the elderly, and young adults (Falsey, 2005; Falsey et al, 2006; Falsey, Hennessey, Formica, Cox, & Walsh, 2005; Falsey & Walsh, 2000, 2005; Kulkarni et al, 2016; O'Shea, Pipkin, Cane, & Gray, 2007; O'Shea, Ryan, Hawksworth, Alsip, & Gray, 2005). Here we showed altered immune responses to RSV in BALB/c mice that have consumed 18% ethanol in their drinking water for 6 weeks.…”

Section: Discussionmentioning

confidence: 99%

RSV-specific anti-viral immunity is disrupted by chronic ethanol consumption

Warren

Simet

Pavlik

et al. 2016

Alcohol

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Alcohol-use disorders (AUD) persist in the United States and are heavily associated with an increased susceptibility to respiratory viral infections. Respiratory syncytial virus (RSV) in particular has received attention as a viral pathogen commonly detected in children and immune-compromised populations (elderly, asthmatics), yet more recently was recognized as an important viral pathogen in young adults. Our study evaluated the exacerbation of RSV-associated illness in mice that chronically consumed alcohol for 6 weeks prior to infection. Prior studies showed that lung viral titers remained elevated in these animals, leading to a hypothesis that T-cell activation and immune specificity were deficient in controlling viral spread and replication in the lungs. Herein, we confirm a reduction in RSV-specific IFNγ production by CD8 T cells and a depolarization of Th1 (CD4+IFNγ+) and Th2 (CD4+IL-4+) T cells at day 5 after RSV infection. Furthermore, over the course of viral infection (day 1 to day 7 after RSV infection), we detected a delayed influx of neutrophils, monocytes/macrophages, and lymphocytes into the lungs. Taken together, the data show that both the early and late adaptive immunity to RSV infection are altered by chronic ethanol consumption. Future studies will determine the interactions between the innate and adaptive immune systems to delineate therapeutic targets for individuals with AUD often hospitalized by respiratory infection.

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Evidence of Respiratory Syncytial Virus Spread by Aerosol. Time to Revisit Infection Control Strategies?

Cited by 123 publications

References 28 publications

Indoor hospital air and the impact of ventilation on bioaerosols: a systematic review

Indoor hospital air and the impact of ventilation on bioaerosols: a systematic review

Particle and bioaerosol characteristics in a paediatric intensive care unit

RSV-specific anti-viral immunity is disrupted by chronic ethanol consumption

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