Abstract
IntroductionWhile influenza A and B viruses can be transmitted via respiratory droplets, the importance of small droplet nuclei “aerosols” in transmission is controversial.Methods and FindingsIn Hong Kong and Bangkok, in 2008–11, subjects were recruited from outpatient clinics if they had recent onset of acute respiratory illness and none of their household contacts were ill. Following a positive rapid influenza diagnostic test result, subjects were randomly allocated to one of three household-based interventions: hand hygiene, hand hygiene plus face masks, and a control group. Index cases plus their household contacts were followed for 7–10 days to identify secondary infections by reverse transcription polymerase chain reaction (RT-PCR) testing of respiratory specimens. Index cases with RT-PCR-confirmed influenza B were included in the present analyses. We used a mathematical model to make inferences on the modes of transmission, facilitated by apparent differences in clinical presentation of secondary infections resulting from aerosol transmission. We estimated that approximately 37% and 26% of influenza B virus transmission was via the aerosol mode in households in Hong Kong and Bangkok, respectively. In the fitted model, influenza B virus infections were associated with a 56%–72% risk of fever plus cough if infected via aerosol route, and a 23%–31% risk of fever plus cough if infected via the other two modes of transmission.ConclusionsAerosol transmission may be an important mode of spread of influenza B virus. The point estimates of aerosol transmission were slightly lower for influenza B virus compared to previously published estimates for influenza A virus in both Hong Kong and Bangkok. Caution should be taken in interpreting these findings because of the multiple assumptions inherent in the model, including that there is limited biological evidence to date supporting a difference in the clinical features of influenza B virus infection by different modes.
Highlights
While influenza A and B viruses can be transmitted via respiratory droplets, the importance of small droplet nuclei ‘‘aerosols’’ in transmission is controversial
Aerosol transmission may be an important mode of spread of influenza B virus
The point estimates of aerosol transmission were slightly lower for influenza B virus compared to previously published estimates for influenza A virus in both Hong Kong and Bangkok
Summary
While influenza A and B viruses can be transmitted via respiratory droplets, the importance of small droplet nuclei ‘‘aerosols’’ in transmission is controversial. The potential for influenza virus to spread by aerosols remains controversial [3,4,5,7,8]. There is growing evidence that influenza A virus can spread by aerosols [3,4,5,8,9,10], but less discussion over the potential role of aerosols in influenza B virus transmission with limited published literature. Infectious influenza B virus can be detected in the aerosol fraction (particles ,5 mm) of exhaled breath of subjects with influenza B virus infection [11]
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