Probable Evidence of Fecal Aerosol Transmission of SARS-CoV-2 in a High-Rise Building.
Journal
Annals of internal medicine
ISSN: 1539-3704
Titre abrégé: Ann Intern Med
Pays: United States
ID NLM: 0372351
Informations de publication
Date de publication:
15 12 2020
15 12 2020
Historique:
pubmed:
2
9
2020
medline:
30
12
2020
entrez:
2
9
2020
Statut:
ppublish
Résumé
The role of fecal aerosols in the transmission of severe acute respiratory syndrome coronavirus 2 has been suspected. To investigate the temporal and spatial distributions of 3 infected families in a high-rise apartment building and examine the associated environmental variables to verify the role of fecal aerosols. Epidemiologic survey and quantitative reverse transcriptase polymerase chain reaction analyses on throat swabs from the participants; 237 surface and air samples from 11 of the 83 flats in the building, public areas, and building drainage systems; and tracer gas released into bathrooms as a surrogate for virus-laden aerosols in the drainage system. A high-rise apartment building in Guangzhou, China. 9 infected patients, 193 other residents of the building, and 24 members of the building's management staff. Locations of infected flats and positive environmental samples, and spread of virus-laden aerosols. 9 infected patients in 3 families were identified. The first family had a history of travel to the coronavirus disease 2019 (COVID-19) epicenter Wuhan, whereas the other 2 families had no travel history and a later onset of symptoms. No evidence was found for transmission via the elevator or elsewhere. The families lived in 3 vertically aligned flats connected by drainage pipes in the master bathrooms. Both the observed infections and the locations of positive environmental samples are consistent with the vertical spread of virus-laden aerosols via these stacks and vents. Inability to determine whether the water seals were dried out in the flats of the infected families. On the basis of circumstantial evidence, fecal aerosol transmission may have caused the community outbreak of COVID-19 in this high-rise building. Key-Area Research and Development Program of Guangdong Province and the Research Grants Council of Hong Kong.
Sections du résumé
BACKGROUND
The role of fecal aerosols in the transmission of severe acute respiratory syndrome coronavirus 2 has been suspected.
OBJECTIVE
To investigate the temporal and spatial distributions of 3 infected families in a high-rise apartment building and examine the associated environmental variables to verify the role of fecal aerosols.
DESIGN
Epidemiologic survey and quantitative reverse transcriptase polymerase chain reaction analyses on throat swabs from the participants; 237 surface and air samples from 11 of the 83 flats in the building, public areas, and building drainage systems; and tracer gas released into bathrooms as a surrogate for virus-laden aerosols in the drainage system.
SETTING
A high-rise apartment building in Guangzhou, China.
PARTICIPANTS
9 infected patients, 193 other residents of the building, and 24 members of the building's management staff.
MEASUREMENTS
Locations of infected flats and positive environmental samples, and spread of virus-laden aerosols.
RESULTS
9 infected patients in 3 families were identified. The first family had a history of travel to the coronavirus disease 2019 (COVID-19) epicenter Wuhan, whereas the other 2 families had no travel history and a later onset of symptoms. No evidence was found for transmission via the elevator or elsewhere. The families lived in 3 vertically aligned flats connected by drainage pipes in the master bathrooms. Both the observed infections and the locations of positive environmental samples are consistent with the vertical spread of virus-laden aerosols via these stacks and vents.
LIMITATION
Inability to determine whether the water seals were dried out in the flats of the infected families.
CONCLUSION
On the basis of circumstantial evidence, fecal aerosol transmission may have caused the community outbreak of COVID-19 in this high-rise building.
PRIMARY FUNDING SOURCE
Key-Area Research and Development Program of Guangdong Province and the Research Grants Council of Hong Kong.
Identifiants
pubmed: 32870707
doi: 10.7326/M20-0928
pmc: PMC7464151
doi:
Substances chimiques
Aerosols
0
RNA, Viral
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
974-980Commentaires et corrections
Type : CommentIn
Références
Lancet. 2020 Feb 15;395(10223):514-523
pubmed: 31986261
N Engl J Med. 2020 Mar 26;382(13):1199-1207
pubmed: 31995857
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
Appl Microbiol. 1975 Aug;30(2):229-37
pubmed: 169732
Nature. 2020 Jun;582(7813):557-560
pubmed: 32340022
J Hosp Infect. 2020 Jul;105(3):397-398
pubmed: 32315667
Aliment Pharmacol Ther. 2020 May;51(9):843-851
pubmed: 32222988
Emerg Microbes Infect. 2020 Dec;9(1):386-389
pubmed: 32065057
Lancet. 2003 May 24;361(9371):1767-72
pubmed: 12781535
N Engl J Med. 2020 Feb 27;382(9):872-874
pubmed: 31991079
N Engl J Med. 2004 Apr 22;350(17):1731-9
pubmed: 15102999
Indoor Air. 2017 Nov;27(6):1201-1212
pubmed: 28378912
N Engl J Med. 2020 Mar 5;382(10):929-936
pubmed: 32004427
Indoor Air. 2018 May;28(3):394-403
pubmed: 29244221
JAMA. 2020 Apr 28;323(16):1610-1612
pubmed: 32129805