Influenza Virus in Human Exhaled Breath: An Observational Study

• Published in: PloS one Vol. 3; no. 7; p. e2691
• Main Authors: Fabian, Patricia, McDevitt, James J., DeHaan, Wesley H., Fung, Rita O. P., Cowling, Benjamin J., Chan, Kwok Hung, Leung, Gabriel M., Milton, Donald K.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16.07.2008; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aerosols; Air; Analysis; Breath Tests; Breathing; Disease transmission; Environmental health; Exhalation; Female; Filters; Flow cytometry; Health aspects; Humans; Infectious Diseases/Viral Infections; Influenza; Influenza A; Influenza A virus; Influenza B; Influenza B virus; Influenza viruses; Influenza, Human - transmission; Male; Measles; Medical research; Medicine; Medicine, Experimental; Middle Aged; Mouth Breathing; Observational studies; Orthomyxoviridae - metabolism; Pandemics; Particle counters; Patients; Polymerase chain reaction; Polytetrafluoroethylene; Public health; Public Health and Epidemiology/Environmental Health; Public Health and Epidemiology/Infectious Diseases; Respiration; Ribonucleic acid; RNA; RNA viruses; RNA, Viral - analysis; Studies; Tidal energy; Tidal power; Viruses; Work environment; Hong Kong China; United States > US; Massachusetts; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0002691

Recent studies suggest that humans exhale fine particles during tidal breathing but little is known of their composition, particularly during infection. We conducted a study of influenza infected patients to characterize influenza virus and particle concentrations in their exhaled breath. Patients presenting with influenza-like-illness, confirmed influenza A or B virus by rapid test, and onset within 3 days were recruited at three clinics in Hong Kong, China. We collected exhaled breath from each subject onto Teflon filters and measured exhaled particle concentrations using an optical particle counter. Filters were analyzed for influenza A and B viruses by quantitative polymerase chain reaction (qPCR). Twelve out of thirteen rapid test positive patients provided exhaled breath filter samples (7 subjects infected with influenza B virus and 5 subjects infected with influenza A virus). We detected influenza virus RNA in the exhaled breath of 4 (33%) subjects--three (60%) of the five patients infected with influenza A virus and one (14%) of the seven infected with influenza B virus. Exhaled influenza virus RNA generation rates ranged from <3.2 to 20 influenza virus RNA particles per minute. Over 87% of particles exhaled were under 1 microm in diameter. These findings regarding influenza virus RNA suggest that influenza virus may be contained in fine particles generated during tidal breathing, and add to the body of literature suggesting that fine particle aerosols may play a role in influenza transmission.