Influenza virus emitted by naturally-infected hosts in a healthcare setting

Mubareka, Samira; Granados, Andrea; Naik, Ushma; Darwish, Ilyse; Cutts, Todd A.; Astrakianakis, George; Gubbay, Jonathan B.; Peci, Adriana; Scott, James A.

BACKGROUND: The emergence of novel respiratory viruses such as avian influenza A(H7N9) virus and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) highlights the importance of understanding determinants of transmission to healthcare workers (HCWs) and the public. OBJECTIVES: We aim to determine the viral content of the air emitted by symptomatic inpatients or long-term care residents with laboratory-confirmed influenza virus infection (emitters), and in the breathing zones of healthcare workers who attend to them. DESIGN: A prospective pilot study of patients with laboratory-confirmed influenza virus infection was undertaken. Air within 1 m of the patient was sampled using a high volume air sampler. In addition, a lower volume air sampler was placed <1 m from the patient, with another >1 m from the patient. Viral RNA was recovered from the samplers and submitted for quantitative real time PCR. In addition, personal button samplers were provided to HCWs. RESULTS: The air emitted by 15 participants with laboratory-confirmed influenza virus infection was sampled. Of the patients infected with influenza A, viral RNA was recovered from the air emitted by 9/12 patients using the low-volume sampler; no viral RNA was detected from air emitted by patients with influenza B (n = 3). Influenza virus RNA was recovered from one HCW’s sampler. CONCLUSIONS: Patients with respiratory virus infection emit virus into the air which disperses to >1 m and may reach the breathing zone of a HCW. This pilot study highlights the feasibility and importance of conducting a larger-scale study to identify determinants of exposure and transmission from patient to HCW.