Article: Possible role of aerosol transmission in a hospital outbreak of influenza

File Download Links for fulltext
(May Require Subscription)
Supplementary
  • Basic View
  • Metadata View
  • XML View
TitlePossible role of aerosol transmission in a hospital outbreak of influenza
AuthorsWong, BCK2
Lee, N2
Li, Y1
Chan, PKS2
Qiu, H2
Luo, Z1
Lai, RWM2
Ngai, KLK2
Hui, DSC2
Choi, KW2
Yu, ITS2
Issue Date2010
PublisherOxford University Press. The Journal's web site is located at http://www.oxfordjournals.org/our_journals/cid/
CitationClinical Infectious Diseases, 2010, v. 51 n. 10, p. 1176-1183 [How to Cite?]
DOI: http://dx.doi.org/10.1086/656743
AbstractBackground. We examined the role of aerosol transmission of influenza in an acute ward setting. Methods. We investigated a seasonal influenza A outbreak that occurred in our general medical ward (with open bay ward layout) in 2008. Clinical and epidemiological information was collected in real time during the outbreak. Spatiotemporal analysis was performed to estimate the infection risk among patients. Airflow measurements were conducted, and concentrations of hypothetical virus-laden aerosols at different ward locations were estimated using computational fluid dynamics modeling. Results. Nine inpatients were infected with an identical strain of influenza A/H3N2 virus. With reference to the index patient's location, the attack rate was 20.0% and 22.2% in the "same" and "adjacent" bays, respectively, but 0% in the "distant" bay (P = .04). Temporally, the risk of being infected was highest on the day when noninvasive ventilation was used in the index patient; multivariate logistic regression revealed an odds ratio of 14.9 (95% confidence interval, 1.7-131.3; P = .015). A simultaneous, directional indoor airflow blown from the "same" bay toward the "adjacent" bay was found; it was inadvertently created by an unopposed air jet from a separate air purifier placed next to the index patient's bed. Computational fluid dynamics modeling revealed that the dispersal pattern of aerosols originated from the index patient coincided with the bed locations of affected patients. Conclusions. Our findings suggest a possible role of aerosol transmission of influenza in an acute ward setting. Source and engineering controls, such as avoiding aerosol generation and improving ventilation design, may warrant consideration to prevent nosocomial outbreaks. © 2010 by the Infectious Diseases Society of America. All rights reserved.
ISSN1058-4838
2011 Impact Factor: 9.154
2011 SCImago Journal Rankings: 0.821
DOIhttp://dx.doi.org/10.1086/656743
ISI Accession Number IDWOS:000283331800011
ReferencesReferences in Scopus
DC Field
Value
dc.contributor.authorWong, BCK
dc.contributor.authorLee, N
dc.contributor.authorLi, Y
dc.contributor.authorChan, PKS
dc.contributor.authorQiu, H
dc.contributor.authorLuo, Z
dc.contributor.authorLai, RWM
dc.contributor.authorNgai, KLK
dc.contributor.authorHui, DSC
dc.contributor.authorChoi, KW
dc.contributor.authorYu, ITS
dc.date.accessioned2011-09-23T05:48:43Z
dc.date.available2011-09-23T05:48:43Z
dc.date.issued2010
dc.description.abstractBackground. We examined the role of aerosol transmission of influenza in an acute ward setting. Methods. We investigated a seasonal influenza A outbreak that occurred in our general medical ward (with open bay ward layout) in 2008. Clinical and epidemiological information was collected in real time during the outbreak. Spatiotemporal analysis was performed to estimate the infection risk among patients. Airflow measurements were conducted, and concentrations of hypothetical virus-laden aerosols at different ward locations were estimated using computational fluid dynamics modeling. Results. Nine inpatients were infected with an identical strain of influenza A/H3N2 virus. With reference to the index patient's location, the attack rate was 20.0% and 22.2% in the "same" and "adjacent" bays, respectively, but 0% in the "distant" bay (P = .04). Temporally, the risk of being infected was highest on the day when noninvasive ventilation was used in the index patient; multivariate logistic regression revealed an odds ratio of 14.9 (95% confidence interval, 1.7-131.3; P = .015). A simultaneous, directional indoor airflow blown from the "same" bay toward the "adjacent" bay was found; it was inadvertently created by an unopposed air jet from a separate air purifier placed next to the index patient's bed. Computational fluid dynamics modeling revealed that the dispersal pattern of aerosols originated from the index patient coincided with the bed locations of affected patients. Conclusions. Our findings suggest a possible role of aerosol transmission of influenza in an acute ward setting. Source and engineering controls, such as avoiding aerosol generation and improving ventilation design, may warrant consideration to prevent nosocomial outbreaks. © 2010 by the Infectious Diseases Society of America. All rights reserved.
dc.description.naturelink_to_OA_fulltext
dc.identifier.citationClinical Infectious Diseases, 2010, v. 51 n. 10, p. 1176-1183 [How to Cite?]
DOI: http://dx.doi.org/10.1086/656743
dc.identifier.citeulike8024719
dc.identifier.doihttp://dx.doi.org/10.1086/656743
dc.identifier.epage1183
dc.identifier.hkuros192413
dc.identifier.isiWOS:000283331800011
dc.identifier.issn1058-4838
2011 Impact Factor: 9.154
2011 SCImago Journal Rankings: 0.821
dc.identifier.issue10
dc.identifier.pmid20942655
dc.identifier.scopuseid_2-s2.0-78349238585
dc.identifier.spage1176
dc.identifier.urihttp://hdl.handle.net/10722/139351
dc.identifier.volume51
dc.languageeng
dc.publisherOxford University Press. The Journal's web site is located at http://www.oxfordjournals.org/our_journals/cid/
dc.publisher.placeUnited States
dc.relation.ispartofClinical Infectious Diseases
dc.relation.referencesReferences in Scopus
dc.subject.meshAir Microbiology
dc.subject.meshAir Movements
dc.subject.meshCross Infection - epidemiology - transmission - virology
dc.subject.meshInfluenza A Virus, H3N2 Subtype - isolation and purification
dc.subject.meshInfluenza, Human - epidemiology - transmission - virology
dc.titlePossible role of aerosol transmission in a hospital outbreak of influenza
dc.typeArticle
Author Affiliations
  1. The University of Hong Kong
  2. Chinese University of Hong Kong