Evidence of Respiratory Syncytial Virus Spread by Aerosol. Time to Revisit Infection Control Strategies?

毛细支气管炎 气溶胶化 医学 呼吸道 病毒 呼吸系统 慢性阻塞性肺病 下呼吸道感染 气溶胶 呼吸道疾病 重症监护 免疫学 病毒学 呼吸道感染 重症监护医学 内科学 吸入 化学 麻醉 有机化学
作者
Hemant Kulkarni,Claire M. Smith,Dani Do Hyang Lee,Robert A. Hirst,Andrew J. Easton,Chris O’Callaghan
出处
期刊:American Journal of Respiratory and Critical Care Medicine [American Thoracic Society]
卷期号:194 (3): 308-316 被引量:124
标识
DOI:10.1164/rccm.201509-1833oc
摘要

Respiratory syncytial virus (RSV) is a highly contagious pathogen with a huge global health impact. It is a major cause of hospital-acquired infection; a large number of those exposed develop infection. Those infected in hospital are at increased risk of a severe clinical course. Prevention of nosocomial spread currently focuses on spread by hand and large droplets. There is little research evidence to determine if aerosol spread of infectious RSV is possible.To determine if the air surrounding infants with RSV-positive bronchiolitis contains RSV in aerosolized particles that remain capable of causing infection.The amount of RSV contained in aerosolized particles produced by infants with bronchiolitis due to RSV was measured using viable impactor sampling. The ability of RSV contained in these particles to infect healthy and chronic obstructive pulmonary disease (COPD) human ciliated respiratory epithelium was determined.We showed for the first time that infants with RSV-positive bronchiolitis nursed in a ward setting or ventilated in intensive care produced large numbers of aerosol particles containing RSV that remained infectious and were capable of infecting healthy and COPD human ciliated epithelium. A significant amount of RSV was found in particles with aerodynamic diameters less than 5 μm.Many of the aerosolized particles that contained RSV in the air surrounding infants with bronchiolitis were sufficiently small to remain airborne for a significant length of time and small enough to be inhaled and deposited throughout the respiratory tract. It is likely that this leads to spread of infection to others, with dissemination of infection throughout the respiratory tract.
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