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• W2516121036 abstract "•Indoor air is an important vehicle for a variety of human pathogens.•Review of airborne transmission of infectious agents from experimental and field studies, predisposing to establish air-surface-air nexus and possible ways of transmission to susceptible hosts.•An overview of the methods for experimentally generating and recovering airborne human pathogens and environmental factors affecting their survival in air.•Current and emerging technologies for decontamination of indoor air for human pathogens.•Design, establishment, and validation of a room-size aerobiology chamber meeting the U.S. Environmental Protection Agency guidelines (2012) that can be used for assessment of air-decontamination technologies. Indoor air can be an important vehicle for a variety of human pathogens. This review provides examples of airborne transmission of infectious agents from experimental and field studies and discusses how airborne pathogens can contaminate other parts of the environment to give rise to secondary vehicles leading air-surface-air nexus with possible transmission to susceptible hosts. The following groups of human pathogens are covered because of their known or potential airborne spread: vegetative bacteria (staphylococci and legionellae), fungi (Aspergillus, Penicillium, and Cladosporium spp and Stachybotrys chartarum), enteric viruses (noro- and rotaviruses), respiratory viruses (influenza and coronaviruses), mycobacteria (tuberculous and nontuberculous), and bacterial spore formers (Clostridium difficile and Bacillus anthracis). An overview of methods for experimentally generating and recovering airborne human pathogens is included, along with a discussion of factors that influence microbial survival in indoor air. Available guidelines from the U.S. Environmental Protection Agency and other global regulatory bodies for the study of airborne pathogens are critically reviewed with particular reference to microbial surrogates that are recommended. Recent developments in experimental facilities to contaminate indoor air with microbial aerosols are presented, along with emerging technologies to decontaminate indoor air under field-relevant conditions. Furthermore, the role that air decontamination may play in reducing the contamination of environmental surfaces and its combined impact on interrupting the risk of pathogen spread in both domestic and institutional settings is discussed. Indoor air can be an important vehicle for a variety of human pathogens. This review provides examples of airborne transmission of infectious agents from experimental and field studies and discusses how airborne pathogens can contaminate other parts of the environment to give rise to secondary vehicles leading air-surface-air nexus with possible transmission to susceptible hosts. The following groups of human pathogens are covered because of their known or potential airborne spread: vegetative bacteria (staphylococci and legionellae), fungi (Aspergillus, Penicillium, and Cladosporium spp and Stachybotrys chartarum), enteric viruses (noro- and rotaviruses), respiratory viruses (influenza and coronaviruses), mycobacteria (tuberculous and nontuberculous), and bacterial spore formers (Clostridium difficile and Bacillus anthracis). An overview of methods for experimentally generating and recovering airborne human pathogens is included, along with a discussion of factors that influence microbial survival in indoor air. Available guidelines from the U.S. Environmental Protection Agency and other global regulatory bodies for the study of airborne pathogens are critically reviewed with particular reference to microbial surrogates that are recommended. Recent developments in experimental facilities to contaminate indoor air with microbial aerosols are presented, along with emerging technologies to decontaminate indoor air under field-relevant conditions. Furthermore, the role that air decontamination may play in reducing the contamination of environmental surfaces and its combined impact on interrupting the risk of pathogen spread in both domestic and institutional settings is discussed. Air, a universal environmental equalizer, affects all living and nonliving forms on planet earth. For humans, it has profound health implications in all indoor environments where we normally spend most of our time.1Fernstrom A. Goldblatt M. Aerobiology and its role in the transmission of infectious diseases.J Pathog. 2013; 2013: 493960Crossref PubMed Google Scholar, 2Kowalski W. Hospital airborne infection control. CRC Press, Boca Raton (FL)2012Google Scholar, 3Traistaru E. Moldovan R. Menelaou A. Kakourou P. Georgescu C. A comparative study on the quality of air in offices and homes.J Environ Sci Health A Tox Hazard Subst Environ Eng. 2013; 48: 1806-1814Crossref PubMed Scopus (7) Google Scholar Air quality is also forever changing because of the influence of many controllable and uncontrollable factors that are virtually everywhere. Indoor air, in particular, can expose us to noxious chemicals, particulates, and a variety of infectious agents, as well as pollen and other allergens.4Mandal J. Brandl H. Bioaerosols in indoor environment–a review with special reference to residential and occupational locations.Open Environ Biol Monit J. 2011; 4: 83-96Crossref Google Scholar, 5Mandin C. Derbez M. Kitchner S. Schools, office buildings, leisure settings: diversity of indoor air quality issues. Global review of indoor air quality in these settings.Ann Pharm Fr. 2012; 70: 204-212Crossref PubMed Scopus (9) Google Scholar Emerging pathogens, such as noroviruses6Nenonen N.P. Hannoun C. Svensson L. Toren K. Andersson L.M. Westin J. et al.Norovirus GII.4 detection in environmental samples from patient rooms during nosocomial outbreaks.J Clin Microbiol. 2014; 52: 2352-2358Crossref PubMed Scopus (41) Google Scholar and Clostridium difficile,7Best E.L. Fawley W.N. Parnell P. Wilcox M.H. The potential for airborne dispersal of Clostridium difficile from symptomatic patients.Clin Infect Dis. 2010; 50: 1450-1457Crossref PubMed Scopus (129) Google Scholar have also been detected in indoor air, with a strong potential for airborne dissemination. Pathogens discharged into the air may settle on environmental surfaces, which could then become secondary vehicles for the spread of infectious agents indoors.8Gralton J. Tovey E. McLaws M.L. Rawlinson W.D. The role of particle size in pathogen transmission: a review.J Infect. 2011; 62: 1-13Abstract Full Text Full Text PDF PubMed Scopus (455) Google Scholar The possible transmission of drug-resistant bacteria by indoor air adds another cause for concern.9Muzlay M. Moore G. Turton J.F. Wilson A.P. Dissemination of antibiotic-resistant enterococci within the ward environment: the role of airborne bacteria and the risk posed by unrecognized carriers.Am J Infect Control. 2013; 41: 57-60Abstract Full Text Full Text PDF Scopus (24) Google Scholar A combination of on-going societal changes is adding further to the potential of air as a vehicle for infectious agents.10Eames I. Tang J.W. Li Y. Wilson P. Airborne transmission of disease in hospitals.J R Soc Interface. 2009; 6: S697-702Crossref PubMed Scopus (160) Google Scholar, 11Sattar S.A. Tetro J. Springthorpe V.S. Impact of changing societal trends on the spread of infectious diseases in American and Canadian homes.Am J Infect Control. 1999; 27: S4-21Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar, 12Yang W. Marr L.C. Dynamics of airborne influenza A viruses indoors and dependence on humidity.PLoS ONE. 2011; 6: e21481Crossref Scopus (178) Google Scholar The quality of indoor air is therefore a prominent public health concern13Sattar S.A. Ijaz M.K. Spread of viral infections by aerosols.Crit Rev Environ Control. 1987; 17: 89-131Crossref Scopus (77) Google Scholar, 14Weis C.P. Intrepido A.J. Miller A.K. Cowin P.G. Durno M.A. Gebhardt J.S. et al.Secondary aerosolization of viable Bacillus anthracis spores in a contaminated US Senate Office.JAMA. 2002; 288: 2853-2858Crossref PubMed Scopus (113) Google Scholar that requires a clear understanding of the transmission processes for the development and implementation of targeted infection prevention and control measures.15Goldmann D.A. Transmission of viral respiratory infections in the home.Pediatr Infect Dis J. 2000; 19: S97-102Crossref PubMed Scopus (148) Google Scholar Although direct and indirect exposure to pathogens in the air can occur by other means, infections from the inhalation and retention, including translocation and ingestion after inhalation of droplet nuclei, are generally regarded as true airborne spread. Aerosols of various sizes that contain infectious agents can be emitted from a variety of sources, such as infected or colonized individuals16Meadow J.F. Altrichter A.E. Bateman A.C. Stenson J. Brown G.Z. Green J.L. et al.Humans differ in their personal microbial cloud.PeerJ. 2015; 3: e1258Crossref Scopus (177) Google Scholar or flushing toilets, and may expose susceptible persons either directly (droplet transmission) or by remaining suspended in the air for inhalation (airborne transmission).17Li Y. Tang J. Noakes C.J. Hoddson M. Engineering control of respiratory infection and low-energy design of healthcare facilities.Sci Technol Built Environ. 2015; 21: 25-34Crossref Scopus (22) Google Scholar, 18Jones R.M. Brosseau L.M. Aerosol transmission of infectious disease.J Occup Environ Med. 2015; 57: 501-508Crossref Scopus (252) Google Scholar Contrary to the conventionally held belief, modeling work has redefined the Wells evaporation-falling curve,19Wells W.F. On airborne infection. Study II. Droplets and droplet nuclei.Am J Hygeine. 1934; 20: 611-618Google Scholar, 20Wells W.F. Airborne contagion and air hygiene. Harvard University Press, Cambridge (MA)1955Google Scholar revealing that expelled large droplets could be carried >6 m away by exhaled air at a velocity of 50 m/s (sneezing), >2 m away at a velocity of 10 m/s (coughing), and <1 m away at a velocity of 1 m/s (breathing), leading to potential transmission of short-range infectious agents that contain aerosols.21Xie X. Li Y. Chwang A.T. Ho P.L. Seto W.H. How far droplets can move in indoor environments–revisiting the Wells evaporation-falling curve.Indoor Air. 2007; 17: 211-225Crossref PubMed Scopus (683) Google Scholar Airborne transmission requires that pathogens survive the process of aerosolization and persist in the air long enough to be transmitted to a susceptible host.22Cox C.S. Airborne bacteria and viruses.Sci Prog. 1989; 73: 469-499PubMed Google Scholar Aerosolized pathogens may settle onto environmental surfaces in the immediate vicinity, leading to genesis of secondary vehicles (Fig 1).23Prussin A.J. Marr L.C. Sources of airborne microorganisms in the built environment.Microbiome. 2015; 3: 78Crossref Scopus (254) Google Scholar This review provides current information on the spread of human pathogens by indoor air, with a focus on the major classes of human pathogens from experimental and field studies, and on emerging air decontamination technologies, including test protocols developed to assess their performance under field-relevant conditions. The study of aerosolized human pathogens requires the ability to produce them experimentally at the appropriate size, store them, and sample them for residual infectious content over a predetermined time period.13Sattar S.A. Ijaz M.K. Spread of viral infections by aerosols.Crit Rev Environ Control. 1987; 17: 89-131Crossref Scopus (77) Google Scholar The equipment must also simulate naturally occurring environmental conditions and the duration of exposure to accurately assess aerosol survivability.24Verreault D. Duchaine C. Marcoux-Voiselle M. Turgeon N. Roy C.J. Design of an environmentally controlled rotating chamber for bioaerosol aging studies.Inhal Toxicol. 2014; 26: 554-558Crossref Scopus (17) Google Scholar Various analytical methods and air samplers have been used to characterize airborne pathogens and overcome the challenges of collecting and analyzing them. Relevant studies have been reviewed in detail elsewhere.13Sattar S.A. Ijaz M.K. Spread of viral infections by aerosols.Crit Rev Environ Control. 1987; 17: 89-131Crossref Scopus (77) Google Scholar, 25Yates M. Nakatsu C. Miller R. Pillai S. Manual of environmental microbiology. 4th ed. ASM Press, Washington (DC)2015Google Scholar, 26Verreault D. Moineau S. Duchaine C. Methods for sampling of airborne viruses.Microbiol Mol Biol Rev. 2008; 72: 413-444Crossref PubMed Scopus (297) Google Scholar Aerosolized microbes must survive the prevailing environmental conditions to potentially infect a susceptible host.22Cox C.S. Airborne bacteria and viruses.Sci Prog. 1989; 73: 469-499PubMed Google Scholar Multiple factors affect airborne survival of microbes indoors (Table 1).13Sattar S.A. Ijaz M.K. Spread of viral infections by aerosols.Crit Rev Environ Control. 1987; 17: 89-131Crossref Scopus (77) Google Scholar, 31Roth Y. Chapnik J.S. Cole P. Feasibility of aerosol vaccination in humans.Ann Otol Rhinol Laryngol. 2003; 112: 264-270Crossref PubMed Scopus (37) Google Scholar The effect of these factors on different types of microbes varies, and generalizations can be difficult because of differences in the experimental methodologies used.27Tang J.W. The effect of environmental parameters on the survival of airborne infectious agents.J R Soc Interface. 2009; 6: S737-46Crossref PubMed Scopus (447) Google Scholar Air temperature, relative humidity (RH), and turbulence are among the more important factors affecting the fate and spread of infectious agents indoors.Table 1Environmental factors associated with survival of airborne infectious agents13Sattar S.A. Ijaz M.K. Spread of viral infections by aerosols.Crit Rev Environ Control. 1987; 17: 89-131Crossref Scopus (77) Google Scholar, 26Verreault D. Moineau S. Duchaine C. Methods for sampling of airborne viruses.Microbiol Mol Biol Rev. 2008; 72: 413-444Crossref PubMed Scopus (297) Google Scholar, 27Tang J.W. The effect of environmental parameters on the survival of airborne infectious agents.J R Soc Interface. 2009; 6: S737-46Crossref PubMed Scopus (447) Google Scholar, 28Yang W. Marr L.C. Mechanisms by which ambient humidity may affect viruses in aerosols.Appl Environ Microbiol. 2012; 78: 6781-6788Crossref Scopus (134) Google Scholar, 29Haleem Khan A.A. Karuppayil S.M. Fungal pollution of indoor environments and its management.Saudi J Biol Sci. 2012; 19: 405-426Crossref Scopus (173) Google Scholar, 30Wang Z. Reponen T. Grinshpun S.A. Gorny R.L. Willeke K. Effect of sampling time and air humidity on the bioefficiency of filter samplers for bioaerosol collection.J Aerosol Sci. 2001; 32: 661-674Crossref Scopus (171) Google ScholarEnvironmental factorVirusesBacteriaFungiTemperature•As temperature increases, survival decreases•DNA viruses are more stable than RNA viruses at higher temperatures•Temperatures >24°C decrease survival•Highest fungal counts occur in the summer, at higher temperaturesRH*RH is a measure of the amount of water vapor in the air at a specific temperature; therefore, temperature and RH always interact to affect survival.•Enveloped viruses (most respiratory viruses, influenza) survive longer at lower RH (20%-30%)•Nonenveloped viruses (adenovirus, rhinovirus, and polio virus) survive longer in higher RH (70%-90%)•Exceptionally, nonenveloped rotaviruses survive best at medium RH•Most gram-negative bacteria survive best in high RH and low temperature, except Klebsiella pneumoniae, which is stable at RH 60%•Gram-positive bacteria have the highest death rates at intermediate RH•Sudden changes in RH reduce survival•Dehydration and rehydration of fungi particles provide conflicting results•Spore concentrations seem higher at higher RHAtmospheric gases•Ozone inactivates airborne viruses to a greater degree than bacteria or fungi•CO decreased survival at low RH (<25%), but protected bacteria at high RH (90%)•Oxygen supports growthLight and irradiation•UV light is harmful (RH-dependent)•UV light is harmful but may be mitigated by higher RH (water coat protects aerosolized particles)•More resilient to the effects of UV light than viruses or bacteriaSurrounding organic material (eg, saliva, mucus)•Protects viruses from environmental changes•May affect survival based on RH•Decomposition of organic waste (food remains) may act as a source of fungal sporesCO, carbon monoxide; RH, relative humidity; UV, ultraviolet.* RH is a measure of the amount of water vapor in the air at a specific temperature; therefore, temperature and RH always interact to affect survival. Open table in a new tab CO, carbon monoxide; RH, relative humidity; UV, ultraviolet. The analysis of air samples for microbes now includes methods that are based on the polymerase chain reaction (PCR). However, PCR-based methods typically cannot differentiate between viable and nonviable microbes.32Brown J.R. Tang J.W. Pankhurst L. Klein N. Gant V. Lai K.M. et al.Influenza virus survival in aerosols and estimates of viable virus loss resulting from aerosolization and air-sampling.J Hosp Infect. 2015; 91: 278-281Abstract Full Text Full Text PDF Scopus (26) Google Scholar A recent study found that PCR substantially overestimated the quantity of infectious airborne influenza virus, but the differences in infectious versus noninfectious virus over time were similar to data from quantification by plaque-forming units, which determined that virus losses were evident within 30-60 minutes postaerosolization.32Brown J.R. Tang J.W. Pankhurst L. Klein N. Gant V. Lai K.M. et al.Influenza virus survival in aerosols and estimates of viable virus loss resulting from aerosolization and air-sampling.J Hosp Infect. 2015; 91: 278-281Abstract Full Text Full Text PDF Scopus (26) Google Scholar Generally, enveloped viruses survive better at lower RH, but there are many exceptions.28Yang W. Marr L.C. Mechanisms by which ambient humidity may affect viruses in aerosols.Appl Environ Microbiol. 2012; 78: 6781-6788Crossref Scopus (134) Google Scholar Other factors that affect aerosol activation in relation to RH include evaporative activity (ie, dehydration, rehydration), surface areas of particles, and pH.28Yang W. Marr L.C. Mechanisms by which ambient humidity may affect viruses in aerosols.Appl Environ Microbiol. 2012; 78: 6781-6788Crossref Scopus (134) Google Scholar Although studies with experimental animals have determined the susceptibility to airborne pathogens and the minimal infective inhalation dose of a given pathogen,25Yates M. Nakatsu C. Miller R. Pillai S. Manual of environmental microbiology. 4th ed. ASM Press, Washington (DC)2015Google Scholar there are wide variations in their test design. First, the number of inhaled microbes may not be known or it may be unrealistically high. Second, the test protocol may not have fully excluded microbial exposure by means other than inhalation. Third, there may be incomplete recording of the environmental conditions (eg, RH, air temperature) to assess their impact on microbial viability. Fourth, pertinent differences may exist between laboratory-adapted strains of the tested microbe compared with strains in the field. Studies using the actual pathogen aerosolized in body fluids provide the strongest evidence of pathogen survivability.18Jones R.M. Brosseau L.M. Aerosol transmission of infectious disease.J Occup Environ Med. 2015; 57: 501-508Crossref Scopus (252) Google Scholar In contrast, field studies face their own set of challenges, which include the noise, bulk, and expense of inefficient air collection devices.25Yates M. Nakatsu C. Miller R. Pillai S. Manual of environmental microbiology. 4th ed. ASM Press, Washington (DC)2015Google Scholar Moreover, passive impingers may not adequately collect low concentrations of pathogens found in the clinical environment.33Booth T.F. Kournikakis B. Bastien N. Ho J. Kobasa D. Stadnyk L. et al.Detection of airborne severe acute respiratory syndrome (SARS) coronavirus and environmental contamination in SARS outbreak units.J Infect Dis. 2005; 191: 1472-1477Crossref PubMed Scopus (328) Google Scholar Slit sampling does not impose size exclusion and may be more effective at recovering viable pathogens of any size.33Booth T.F. Kournikakis B. Bastien N. Ho J. Kobasa D. Stadnyk L. et al.Detection of airborne severe acute respiratory syndrome (SARS) coronavirus and environmental contamination in SARS outbreak units.J Infect Dis. 2005; 191: 1472-1477Crossref PubMed Scopus (328) Google Scholar From a methodologic perspective, field studies also must control for potential variables, such as air turbulence or human activity in areas proximate to sampling, such that sampling occurs before, during, and after an area is occupied and should include functioning ventilation systems.34Srikanth P. Sudharsanam S. Steinberg R. Bio-aerosols in indoor environment: composition, health effects and analysis.Indian J Med Microbiol. 2008; 26: 302-312Crossref Scopus (164) Google Scholar We have previously reviewed published studies on the airborne spread of viruses of animals and humans.13Sattar S.A. Ijaz M.K. Spread of viral infections by aerosols.Crit Rev Environ Control. 1987; 17: 89-131Crossref Scopus (77) Google Scholar, 25Yates M. Nakatsu C. Miller R. Pillai S. Manual of environmental microbiology. 4th ed. ASM Press, Washington (DC)2015Google Scholar Table 2 summarizes key human pathogens with evidence of aerosol transmission. A number of these pathogens causes severe disease, and their classification as high risk by the U.S. Centers for Disease Control and Prevention and the World Health Organization emphasizes the need for appropriate control measures.18Jones R.M. Brosseau L.M. Aerosol transmission of infectious disease.J Occup Environ Med. 2015; 57: 501-508Crossref Scopus (252) Google ScholarTable 2Key human pathogens with evidence of aerosol transmission18Jones R.M. Brosseau L.M. Aerosol transmission of infectious disease.J Occup Environ Med. 2015; 57: 501-508Crossref Scopus (252) Google ScholarVirusesBacteriaEnteric•Norovirus•RotavirusRespiratory•Hantavirus (Sin Nombre virus)•Influenza virus•Rhinovirus•Coronaviruses (eg, SARS)Neurologic•Rabies virusSkin•Chickenpox•Measles•Mumps•Monkeypox/smallpox•Staphylococcus spp, particularly concerning is MRSA•Mycobacterium tuberculosis•Legionella pneumophila•Clostridium difficile•Bacillus anthracisFungiAspergillus sppPenicillium sppCladosporium sppStachybotrys chartarumMRSA, methicillin-resistant Staphylococcus aureus; SARS, severe acute respiratory syndrome. Open table in a new tab MRSA, methicillin-resistant Staphylococcus aureus; SARS, severe acute respiratory syndrome. Experimental studies have used surrogates for human pathogenic enveloped and nonenveloped viruses, such as Cystovirus (ϕ6) and bacteriophage MS-2, respectively.35Aranha-Creado H. Brandwein H. Application of bacteriophages as surrogates for mammalian viruses: a case for use in filter validation based on precedents and current practices in medical and environmental virology.http://www.pall.com/ps/PDFGenerator?URL=http://www.pall.com/main/oem-materials-and-devices/literature-library-details-print-pdf.page?id=3624Google Scholar Enteric viruses are transmitted primarily by the fecal-oral route, but airborne transmission has been reported.13Sattar S.A. Ijaz M.K. Spread of viral infections by aerosols.Crit Rev Environ Control. 1987; 17: 89-131Crossref Scopus (77) Google Scholar Airborne transmission of norovirus may be possible via aerosolization of vomitus and toilet flushing, which are regarded as potential sources of both indoor air and environmental surface contamination. Enteric bacteria and viruses have been recovered from indoor air and environmental surfaces in areas surrounding toilets.18Jones R.M. Brosseau L.M. 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Comparison of the airborne survival of calf rotavirus and poliovirus type 1 (Sabin) aerosolized as a mixture.Appl Environ Microbiol. 1985; 49: 289-293Google Scholar, 40Ijaz M.K. Sattar S.A. Alkarmi T. Dar F.K. Bhatti A.R. Elhag K.M. Studies on the survival of aerosolized bovine rotavirus (UK) and a murine rotavirus.Comp Immunol Microbiol Infect Dis. 1994; 17: 91-98Crossref Scopus (21) Google Scholar These results contradicted a prior study by Moe and Harper,41Moe K. Harper G.J. The effect of relative humidity and temperature on the survival of bovine rotavirus in aerosol.Arch Virol. 1983; 76: 211-216Crossref Scopus (30) Google Scholar in which the UK strain of calf rotavirus was reported to survive best at low and high RH, but not at high temperature.41Moe K. Harper G.J. The effect of relative humidity and temperature on the survival of bovine rotavirus in aerosol.Arch Virol. 1983; 76: 211-216Crossref Scopus (30) Google Scholar Subsequent studies on human rotavirus,39Ijaz M.K. Sattar S.A. Johnson-Lussenburg C.M. Springthorpe V.S. Comparison of the airborne survival of calf rotavirus and poliovirus type 1 (Sabin) aerosolized as a mixture.Appl Environ Microbiol. 1985; 49: 289-293Google Scholar murine rotavirus, and a UK strain of calf rotavirus, aerosolized under the same experimental setup, confirmed the behavior of all strains of rotaviruses are similar in airborne state.39Ijaz M.K. Sattar S.A. Johnson-Lussenburg C.M. Springthorpe V.S. Comparison of the airborne survival of calf rotavirus and poliovirus type 1 (Sabin) aerosolized as a mixture.Appl Environ Microbiol. 1985; 49: 289-293Google Scholar, 40Ijaz M.K. Sattar S.A. Alkarmi T. Dar F.K. Bhatti A.R. Elhag K.M. 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Dynamics of airborne influenza A viruses indoors and dependence on humidity.PLoS ONE. 2011; 6: e21481Crossref Scopus (178) Google Scholar A recent study confirmed recovery of influenza virus from the air emitted by infected persons at distances of 0.5-1.5 m, which could reach the breathing zone of susceptible individuals, including health care workers.44Mubareka S. Granados A. Naik U. Darwish I. Cutts T.A. Astrakianakis G. et al.Influenza virus emitted by naturally-infected hosts in a healthcare setting.J Clin Virol. 2015; 73: 105-107Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Surprisingly, and in spite of much study, the exact mode of and the relative importance of various types of vehicles for transmission of rhinoviruses, which are the most frequent cause of the common cold, remain shrouded in mystery.45Dick E.C. Jennings L.C. Mink K.A. Wartgow C.D. Inhorn S.L. 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• W2516121036 title "Generic aspects of the airborne spread of human pathogens indoors and emerging air decontamination technologies" @default.
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