11/11/2018 Influenza virus transmission

In uenza virus transmission

29 APRIL 2009

In uenza virus may be transmi ed

among humans in three ways: (1) by
direct contact with infected
individuals; (2) by contact with
contaminated objects (called fomites,
such as toys, doorknobs); and (3) by
inhala on of virus-laden aerosols. The
contribu on of each mode to overall
transmission of in uenza is not known. However, CDC recommenda ons to
control in uenza virus transmission in health care se ngs include measures that
minimize spread by aerosol and fomite mechanisms.

Respiratory transmission depends upon the produc on of aerosols that contain

virus par cles. Speaking, singing, and normal breathing all produce aerosols,
while coughing and sneezing lead to more forceful expulsion. While coughing
may produce several hundred droplets, a good sneeze can generate up to 20,ooo.
Aerosolized par cles produced by these ac vi es are of di erent sizes. The
largest droplets fall to the ground within a few meters and will transmit an
infec on only to those in the immediate vicinity. Other droplets travel a distance
determined by their size. Those droplets 1-4 microns in diameter are called
‘droplet nuclei’; these remain suspended in the air for very long periods and may
not only travel long distances, but can reach the lower respiratory tract.

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Inhala on of droplets and droplet nuclei places virus in the upper respiratory
tract, where it may ini ate infec on.

The importance of aerosol transmission is illustrated by an outbreak of in uenza

aboard a commercial airplane in the late 1970s. The plane, carrying 54 persons,
was delayed on the ground for three hours, during which me the ven la on
system was not func onal. Most of the travelers remained on board. Within 72
hours, nearly 75% of the passengers developed in uenza. The source of the
infec on was a single person on the airplane with in uenza.

Nasal secre ons, which contain virus par cles, are responsible for transmission
by direct contact or by contaminated objects. An infected person will frequently
touch their nose or conjunc va, placing virus on the hand. In mate or non-
in mate contact (e.g. shaking hands) will transfer the virus to another person,
who will then infect themselves by touching their nose or eyes. When
contaminated hands touch other objects, the virus is transferred to them. In one
study, 23-59% of objects from homes and day care facili es were shown to
harbor in uenza viral RNA. Others have shown that infec ous in uenza virus
may be persist on paper currency for several weeks.

In uenza transmission can be reduced by covering your nose and mouth when
coughing or sneezing, and by washing hands o en with soap and water or
alcohol-based hand cleaners. Note that CDC does not recommend the use of
face masks for reducing viral spread. It is important to recognize that, in human
infec ons, maximum levels of virus shedding may occur about a day before the
peak of symptoms.

Ethical considera ons preclude controlled in uenza virus transmission studies in

humans, and therefore animal models must be used. Ferrets are suscep ble to
many strains of in uenza virus, and develop symptoms similar to those in
humans. However these animals are costly and di cult to house, precluding their
use in most large scale transmission studies. The guinea pig has recently been
described as an alterna ve animal model for studying in uenza virus
transmission. These animals are suscep ble to di erent viral strains, and the virus

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replicates to high ters in the respiratory tract. The guinea pig was used to show
that transmission of in uenza virus occurs by aerosols and through contaminated
environmental surfaces. The e ciency of aerosol transmission in the guinea pig
model is regulated by temperature and humidity.

Fabian, P., McDevi , J., DeHaan, W., Fung, R., Cowling, B., Chan, K., Leung, G., &
Milton, D. (2008). In uenza Virus in Human Exhaled Breath: An Observa onal
Study PLoS ONE, 3 (7) DOI: 10.1371/journal.pone.0002691

Carrat, F., Vergu, E., Ferguson, N., Lemaitre, M., Cauchemez, S., Leach, S., &
Valleron, A. (2008). Time Lines of Infec on and Disease in Human In uenza: A
Review of Volunteer Challenge Studies American Journal of Epidemiology, 167 (7),
775-785 DOI: 10.1093/aje/kwm375

Mubareka, S., Lowen, A., Steel, J., Coates, A., García‐Sastre, A., & Palese, P.
(2009). Transmission of In uenza Virus via Aerosols and Fomites in the Guinea
Pig Model The Journal of Infec ous Diseases, 199 (6), 858-865 DOI:
10.1086/597073

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