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

TitlePossible role of aerosol transmission in a hospital outbreak of influenza
Authors
Issue Date2010
PublisherOxford University Press. The Journal's web site is located at http://www.oxfordjournals.org/our_journals/cid/
Citation
Clinical Infectious Diseases, 2010, v. 51 n. 10, p. 1176-1183 How to Cite?
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.
Persistent Identifierhttp://hdl.handle.net/10722/139351
ISSN
2015 Impact Factor: 8.736
2015 SCImago Journal Rankings: 4.742
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorWong, BCKen_HK
dc.contributor.authorLee, Nen_HK
dc.contributor.authorLi, Yen_HK
dc.contributor.authorChan, PKSen_HK
dc.contributor.authorQiu, Hen_HK
dc.contributor.authorLuo, Zen_HK
dc.contributor.authorLai, RWMen_HK
dc.contributor.authorNgai, KLKen_HK
dc.contributor.authorHui, DSCen_HK
dc.contributor.authorChoi, KWen_HK
dc.contributor.authorYu, ITSen_HK
dc.date.accessioned2011-09-23T05:48:43Z-
dc.date.available2011-09-23T05:48:43Z-
dc.date.issued2010en_HK
dc.identifier.citationClinical Infectious Diseases, 2010, v. 51 n. 10, p. 1176-1183en_HK
dc.identifier.issn1058-4838en_HK
dc.identifier.urihttp://hdl.handle.net/10722/139351-
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.en_HK
dc.languageengen_US
dc.publisherOxford University Press. The Journal's web site is located at http://www.oxfordjournals.org/our_journals/cid/en_HK
dc.relation.ispartofClinical Infectious Diseasesen_HK
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 influenzaen_HK
dc.typeArticleen_HK
dc.identifier.emailLi, Y:liyg@hkucc.hku.hken_HK
dc.identifier.authorityLi, Y=rp00151en_HK
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1086/656743en_HK
dc.identifier.pmid20942655-
dc.identifier.scopuseid_2-s2.0-78349238585en_HK
dc.identifier.hkuros192413en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-78349238585&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume51en_HK
dc.identifier.issue10en_HK
dc.identifier.spage1176en_HK
dc.identifier.epage1183en_HK
dc.identifier.isiWOS:000283331800011-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridWong, BCK=14832083000en_HK
dc.identifier.scopusauthoridLee, N=7402722286en_HK
dc.identifier.scopusauthoridLi, Y=7502094052en_HK
dc.identifier.scopusauthoridChan, PKS=7403497792en_HK
dc.identifier.scopusauthoridQiu, H=35238145600en_HK
dc.identifier.scopusauthoridLuo, Z=35746716000en_HK
dc.identifier.scopusauthoridLai, RWM=8916364700en_HK
dc.identifier.scopusauthoridNgai, KLK=23995486100en_HK
dc.identifier.scopusauthoridHui, DSC=7101862411en_HK
dc.identifier.scopusauthoridChoi, KW=36985287700en_HK
dc.identifier.scopusauthoridYu, ITS=7102120508en_HK
dc.identifier.citeulike8024719-

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