Possible Role of Aerosol Transmission in a Hospital Outbreak of Influenza
Identifieur interne : 002633 ( Main/Exploration ); précédent : 002632; suivant : 002634Possible Role of Aerosol Transmission in a Hospital Outbreak of Influenza
Auteurs : Bonnie C. K. Wong [République populaire de Chine] ; Nelson Lee [République populaire de Chine, Hong Kong] ; Yuguo Li [République populaire de Chine] ; Paul K. S. Chan [République populaire de Chine] ; Hong Qiu [République populaire de Chine] ; Zhiwen Luo [République populaire de Chine] ; Raymond W. M. Lai [République populaire de Chine] ; Karry L. K. Ngai [République populaire de Chine] ; David S. C. Hui [République populaire de Chine] ; K. W. Choi [République populaire de Chine] ; Ignatius T. S. Yu [République populaire de Chine]Source :
- Clinical Infectious Diseases [ 1058-4838 ] ; 2010.
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'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.
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DOI: 10.1086/656743
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Chan</name></author><author><name sortKey="Qiu, Hong" sort="Qiu, Hong" uniqKey="Qiu H" first="Hong" last="Qiu">Hong Qiu</name></author><author><name sortKey="Luo, Zhiwen" sort="Luo, Zhiwen" uniqKey="Luo Z" first="Zhiwen" last="Luo">Zhiwen Luo</name></author><author><name sortKey="Lai, Raymond W M" sort="Lai, Raymond W M" uniqKey="Lai R" first="Raymond W. M." last="Lai">Raymond W. M. Lai</name></author><author><name sortKey="Ngai, Karry L K" sort="Ngai, Karry L K" uniqKey="Ngai K" first="Karry L. K." last="Ngai">Karry L. K. Ngai</name></author><author><name sortKey="Hui, David S C" sort="Hui, David S C" uniqKey="Hui D" first="David S. C." last="Hui">David S. C. Hui</name></author><author><name sortKey="Choi, K W" sort="Choi, K W" uniqKey="Choi K" first="K. W." last="Choi">K. W. Choi</name></author><author><name sortKey="Yu, Ignatius T S" sort="Yu, Ignatius T S" uniqKey="Yu I" first="Ignatius T. S." last="Yu">Ignatius T. S. 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K." last="Wong">Bonnie C. K. Wong</name><affiliation wicri:level="4"><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Lee, Nelson" sort="Lee, Nelson" uniqKey="Lee N" first="Nelson" last="Lee">Nelson Lee</name><affiliation wicri:level="4"><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Hong Kong</country></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Hong Kong</country><wicri:regionArea>Reprints or correspondence: Prof Nelson Lee, Div of Infectious Diseases, 9/F Clinical Sciences Building, Dept of Medicine and Therapeutics, Prince of Wales Hospital, Shatin</wicri:regionArea><wicri:noRegion>Shatin</wicri:noRegion></affiliation></author><author><name sortKey="Li, Yuguo" sort="Li, Yuguo" uniqKey="Li Y" first="Yuguo" last="Li">Yuguo Li</name><affiliation wicri:level="1"><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Mechanical Engineering, University of Hong Kong, Hong Kong</wicri:regionArea><wicri:noRegion>Hong Kong</wicri:noRegion></affiliation></author><author><name sortKey="Chan, Paul K S" sort="Chan, Paul K S" uniqKey="Chan P" first="Paul K. S." last="Chan">Paul K. S. Chan</name><affiliation wicri:level="4"><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Microbiology, The Chinese University of Hong Kong, Hong Kong</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Qiu, Hong" sort="Qiu, Hong" uniqKey="Qiu H" first="Hong" last="Qiu">Hong Qiu</name><affiliation wicri:level="4"><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Community and Family Medicine, The Chinese University of Hong Kong, Hong Kong</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Luo, Zhiwen" sort="Luo, Zhiwen" uniqKey="Luo Z" first="Zhiwen" last="Luo">Zhiwen Luo</name><affiliation wicri:level="1"><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Mechanical Engineering, University of Hong Kong, Hong Kong</wicri:regionArea><wicri:noRegion>Hong Kong</wicri:noRegion></affiliation></author><author><name sortKey="Lai, Raymond W M" sort="Lai, Raymond W M" uniqKey="Lai R" first="Raymond W. M." last="Lai">Raymond W. M. Lai</name><affiliation wicri:level="4"><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Microbiology, The Chinese University of Hong Kong, Hong Kong</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Ngai, Karry L K" sort="Ngai, Karry L K" uniqKey="Ngai K" first="Karry L. K." last="Ngai">Karry L. K. Ngai</name><affiliation wicri:level="4"><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Microbiology, The Chinese University of Hong Kong, Hong Kong</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Hui, David S C" sort="Hui, David S C" uniqKey="Hui D" first="David S. C." last="Hui">David S. C. Hui</name><affiliation wicri:level="4"><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Choi, K W" sort="Choi, K W" uniqKey="Choi K" first="K. W." last="Choi">K. W. Choi</name><affiliation wicri:level="4"><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Yu, Ignatius T S" sort="Yu, Ignatius T S" uniqKey="Yu I" first="Ignatius T. S." last="Yu">Ignatius T. S. Yu</name><affiliation wicri:level="4"><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Community and Family Medicine, The Chinese University of Hong Kong, Hong Kong</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Clinical Infectious Diseases</title><title level="j" type="abbrev">Clinical Infectious Diseases</title><idno type="ISSN">1058-4838</idno><idno type="eISSN">1537-6591</idno><imprint><publisher>The University of Chicago Press</publisher><date type="published">2010</date><biblScope unit="vol">51</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="1176">1176</biblScope><biblScope unit="page" to="1183">1183</biblScope></imprint><idno type="ISSN">1058-4838</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1058-4838</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="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'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.</div></front></TEI><affiliations><list><country><li>Hong Kong</li><li>République populaire de Chine</li></country><settlement><li>Sha Tin</li></settlement><orgName><li>Université chinoise de Hong Kong</li></orgName></list><tree><country name="République populaire de Chine"><noRegion><name sortKey="Wong, Bonnie C K" sort="Wong, Bonnie C K" uniqKey="Wong B" first="Bonnie C. K." last="Wong">Bonnie C. K. Wong</name></noRegion><name sortKey="Chan, Paul K S" sort="Chan, Paul K S" uniqKey="Chan P" first="Paul K. S." last="Chan">Paul K. S. Chan</name><name sortKey="Choi, K W" sort="Choi, K W" uniqKey="Choi K" first="K. W." last="Choi">K. W. Choi</name><name sortKey="Hui, David S C" sort="Hui, David S C" uniqKey="Hui D" first="David S. C." last="Hui">David S. C. Hui</name><name sortKey="Lai, Raymond W M" sort="Lai, Raymond W M" uniqKey="Lai R" first="Raymond W. M." last="Lai">Raymond W. M. Lai</name><name sortKey="Lee, Nelson" sort="Lee, Nelson" uniqKey="Lee N" first="Nelson" last="Lee">Nelson Lee</name><name sortKey="Li, Yuguo" sort="Li, Yuguo" uniqKey="Li Y" first="Yuguo" last="Li">Yuguo Li</name><name sortKey="Luo, Zhiwen" sort="Luo, Zhiwen" uniqKey="Luo Z" first="Zhiwen" last="Luo">Zhiwen Luo</name><name sortKey="Ngai, Karry L K" sort="Ngai, Karry L K" uniqKey="Ngai K" first="Karry L. K." last="Ngai">Karry L. K. Ngai</name><name sortKey="Qiu, Hong" sort="Qiu, Hong" uniqKey="Qiu H" first="Hong" last="Qiu">Hong Qiu</name><name sortKey="Yu, Ignatius T S" sort="Yu, Ignatius T S" uniqKey="Yu I" first="Ignatius T. S." last="Yu">Ignatius T. S. Yu</name></country><country name="Hong Kong"><noRegion><name sortKey="Lee, Nelson" sort="Lee, Nelson" uniqKey="Lee N" first="Nelson" last="Lee">Nelson Lee</name></noRegion><name sortKey="Lee, Nelson" sort="Lee, Nelson" uniqKey="Lee N" first="Nelson" last="Lee">Nelson Lee</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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