Minimal transmission in an influenza A (H3N2) human challenge-transmission model with exposure events in a controlled environment

MedRxiv : the Preprint Server for Health Sciences
J. S. Nguyen-Van-TamD. K. Milton


Uncertainty about the relative importance of modes of influenza transmission, particularly airborne droplet nuclei (aerosols), fuels controversy concerning recommendations for healthcare worker protection during pandemics. In-depth review by an expert panel, a proof-of-concept study, and an international workshop concluded that human challenge-transmission studies in well-controlled environments would be the most promising approach to fill this critical knowledge gap. Healthy, seronegative volunteer Donors (n=52) were randomly selected for intranasal challenge with influenza A/Wisconsin/67/2005 (H3N2). Seronegative Recipients randomized to Intervention (IR, n=40) or Control (CR, n=35) groups were exposed to Donors for four days. IRs wore face shields and hand sanitized frequently to limit large droplet and contact transmission. Intranasal inoculation produced an infection rate of 81% (42/52); 60% (25/42) of infected Donors had influenza-like illness, 14% (6/42) had fever, and 26% (11/42) had mild or no symptoms. Viral aerosol shedding was observed from 26% (11/42) of the infected Donors. One transmitted infection was confirmed by serology in a CR, yielding a SAR of 2.9% among CR, 0% in IR (p=0.47 for group difference), and 1.3%...Continue Reading

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