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Relative Contributions of Four Exposure Pathways to Influenza Infection Risk

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  • Mark Nicas
  • Rachael M. Jones

Abstract

The relative contribution of four influenza virus exposure pathways—(1) virus‐contaminated hand contact with facial membranes, (2) inhalation of respirable cough particles, (3) inhalation of inspirable cough particles, and (4) spray of cough droplets onto facial membranes—must be quantified to determine the potential efficacy of nonpharmaceutical interventions of transmission. We used a mathematical model to estimate the relative contributions of the four pathways to infection risk in the context of a person attending a bed‐ridden family member ill with influenza. Considering the uncertainties in the sparse human subject influenza dose‐response data, we assumed alternative ratios of 3,200:1 and 1:1 for the infectivity of inhaled respirable virus to intranasally instilled virus. For the 3,200:1 ratio, pathways (1), (2), and (4) contribute substantially to influenza risk: at a virus saliva concentration of 106 mL−1, pathways (1), (2), (3), and (4) contribute, respectively, 31%, 17%, 0.52%, and 52% of the infection risk. With increasing virus concentrations, pathway (2) increases in importance, while pathway (4) decreases in importance. In contrast, for the 1:1 infectivity ratio, pathway (1) is the most important overall: at a virus saliva concentration of 106 mL−1, pathways (1), (2), (3), and (4) contribute, respectively, 93%, 0.037%, 3.3%, and 3.7% of the infection risk. With increasing virus concentrations, pathway (3) increases in importance, while pathway (4) decreases in importance. Given the sparse knowledge concerning influenza dose and infectivity via different exposure pathways, nonpharmaceutical interventions for influenza should simultaneously address potential exposure via hand contact to the face, inhalation, and droplet spray.

Suggested Citation

  • Mark Nicas & Rachael M. Jones, 2009. "Relative Contributions of Four Exposure Pathways to Influenza Infection Risk," Risk Analysis, John Wiley & Sons, vol. 29(9), pages 1292-1303, September.
  • Handle: RePEc:wly:riskan:v:29:y:2009:i:9:p:1292-1303
    DOI: 10.1111/j.1539-6924.2009.01253.x
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    2. Rachael M. Jones, 2011. "Critical Review and Uncertainty Analysis of Factors Influencing Influenza Transmission," Risk Analysis, John Wiley & Sons, vol. 31(8), pages 1226-1242, August.
    3. Nan Zhang & Yuguo Li, 2018. "Transmission of Influenza A in a Student Office Based on Realistic Person-to-Person Contact and Surface Touch Behaviour," IJERPH, MDPI, vol. 15(8), pages 1-20, August.
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    5. Edward M. Fisher & John D. Noti & William G. Lindsley & Francoise M. Blachere & Ronald E. Shaffer, 2014. "Validation and Application of Models to Predict Facemask Influenza Contamination in Healthcare Settings," Risk Analysis, John Wiley & Sons, vol. 34(8), pages 1423-1434, August.
    6. Umesh Adhikari & Alexandre Chabrelie & Mark Weir & Kevin Boehnke & Erica McKenzie & Luisa Ikner & Meng Wang & Qing Wang & Kyana Young & Charles N. Haas & Joan Rose & Jade Mitchell, 2019. "A Case Study Evaluating the Risk of Infection from Middle Eastern Respiratory Syndrome Coronavirus (MERS‐CoV) in a Hospital Setting Through Bioaerosols," Risk Analysis, John Wiley & Sons, vol. 39(12), pages 2608-2624, December.
    7. Christos Nicolaides & Demetris Avraam & Luis Cueto‐Felgueroso & Marta C. González & Ruben Juanes, 2020. "Hand‐Hygiene Mitigation Strategies Against Global Disease Spreading through the Air Transportation Network," Risk Analysis, John Wiley & Sons, vol. 40(4), pages 723-740, April.
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    9. Yuke Wang & Christine L. Moe & Peter F. M. Teunis, 2018. "Children Are Exposed to Fecal Contamination via Multiple Interconnected Pathways: A Network Model for Exposure Assessment," Risk Analysis, John Wiley & Sons, vol. 38(11), pages 2478-2496, November.
    10. Nicole C. J. Brienen & Aura Timen & Jacco Wallinga & Jim E. Van Steenbergen & Peter F. M. Teunis, 2010. "The Effect of Mask Use on the Spread of Influenza During a Pandemic," Risk Analysis, John Wiley & Sons, vol. 30(8), pages 1210-1218, August.
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    13. Alexandre Chabrelie & Jade Mitchell & Joan Rose & Duane Charbonneau & Yoshiki Ishida, 2018. "Evaluation of the Influenza Risk Reduction from Antimicrobial Spray Application on Porous Surfaces," Risk Analysis, John Wiley & Sons, vol. 38(7), pages 1502-1517, July.
    14. Behrouz Pirouz & Stefania Anna Palermo & Seyed Navid Naghib & Domenico Mazzeo & Michele Turco & Patrizia Piro, 2021. "The Role of HVAC Design and Windows on the Indoor Airflow Pattern and ACH," Sustainability, MDPI, vol. 13(14), pages 1-31, July.
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