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. 2015;12(2):107-13.
doi: 10.1080/15459624.2014.973113.

Viable influenza A virus in airborne particles from human coughs

William G Lindsley  1 , John D Noti, Francoise M Blachere, Robert E Thewlis, Stephen B Martin, Sreekumar Othumpangat, Bahar Noorbakhsh, William T Goldsmith, Abhishek Vishnu, Jan E Palmer, Karen E Clark, Donald H Beezhold
Affiliations

Viable influenza A virus in airborne particles from human coughs

William G Lindsley et al. J Occup Environ Hyg. 2015.

Abstract

Patients with influenza release aerosol particles containing the virus into their environment. However, the importance of airborne transmission in the spread of influenza is unclear, in part because of a lack of information about the infectivity of the airborne virus. The purpose of this study was to determine the amount of viable influenza A virus that was expelled by patients in aerosol particles while coughing. Sixty-four symptomatic adult volunteer outpatients were asked to cough 6 times into a cough aerosol collection system. Seventeen of these participants tested positive for influenza A virus by viral plaque assay (VPA) with confirmation by viral replication assay (VRA). Viable influenza A virus was detected in the cough aerosol particles from 7 of these 17 test subjects (41%). Viable influenza A virus was found in the smallest particle size fraction (0.3 μm to 8 μm), with a mean of 142 plaque-forming units (SD 215) expelled during the 6 coughs in particles of this size. These results suggest that a significant proportion of patients with influenza A release small airborne particles containing viable virus into the environment. Although the amounts of influenza A detected in cough aerosol particles during our experiments were relatively low, larger quantities could be expelled by influenza patients during a pandemic when illnesses would be more severe. Our findings support the idea that airborne infectious particles could play an important role in the spread of influenza.

Keywords: aerosols; air microbiology; airborne transmission; cough; infectious disease transmission; influenza.

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Figures

FIGURE 1
FIGURE 1. Cough aerosol particle collection system. Before each cough, the piston spirometer was purged and partially filled with 4 L of dry filtered air. When the patient coughed into the mouthpiece, the cough flowed through an ultrasonic spirometer which measured the cough volume and flow rate. The cough then flowed through a valve and into the piston spirometer, displacing the piston to the right. The droplet tray collected any large drops that impacted it. When the subject finished coughing, the valve was closed and the SKC BioSampler was turned on. The cough aerosol was pulled out of the spirometer and collected by the aerosol sampler. Airborne droplets larger than about 10–15 μm collected in the sampler elbow, while smaller particles were collected in the sampler collection media. As the aerosol sampler drew air, the piston moved to the left until no air remained in the spirometer.
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