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Article: Possible role of aerosol transmission in a hospital outbreak of influenza
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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
2013 Impact Factor: 9.416
 
DOIhttp://dx.doi.org/10.1086/656743
 
ISI Accession Number IDWOS:000283331800011
 
ReferencesReferences in Scopus
 
DC FieldValue
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
2013 Impact Factor: 9.416
 
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
 
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<contributor.author>Li, Y</contributor.author>
<contributor.author>Chan, PKS</contributor.author>
<contributor.author>Qiu, H</contributor.author>
<contributor.author>Luo, Z</contributor.author>
<contributor.author>Lai, RWM</contributor.author>
<contributor.author>Ngai, KLK</contributor.author>
<contributor.author>Hui, DSC</contributor.author>
<contributor.author>Choi, KW</contributor.author>
<contributor.author>Yu, ITS</contributor.author>
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<description.abstract>Background. 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&apos;s location, the attack rate was 20.0% and 22.2% in the &quot;same&quot; and &quot;adjacent&quot; bays, respectively, but 0% in the &quot;distant&quot; 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 &quot;same&quot; bay toward the &quot;adjacent&quot; bay was found; it was inadvertently created by an unopposed air jet from a separate air purifier placed next to the index patient&apos;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. &#169; 2010 by the Infectious Diseases Society of America. All rights reserved.</description.abstract>
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Author Affiliations
  1. The University of Hong Kong
  2. Chinese University of Hong Kong