[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]
Risk Anal. 2019 Sep 16. doi: 10.1111/risa.13389. [Epub ahead of print]
A Case Study Evaluating the Risk of Infection from Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) in a Hospital Setting Through Bioaerosols.
Adhikari U1, Chabrelie A1, Weir M2, Boehnke K3, McKenzie E4, Ikner L5, Wang M6, Wang Q7, Young K8, Haas CN9, Rose J8, Mitchell J1.
Author information: 1 Department of Biosystems and Agricultural Engineering, Michigan State University, East Lansing, MI, USA. 2 Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA. 3 Department of Anesthesiology & the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA. 4 Department of Civil and Environmental Engineering, Temple University, Philadelphia, PA, USA. 5 Department of Soil, Water and Environmental Science, University of Arizona, Tucson, AZ, USA. 6 Department of Civil & Environmental Engineering, University of South Florida, Tampa, FL, USA. 7 Department of Animal and Food Sciences, University of Delaware, Newark, DE, USA. 8 Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, USA. 9 Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, USA.
Middle Eastern respiratory syndrome, an emerging viral infection with a global case fatality rate of 35.5%, caused major outbreaks first in 2012 and 2015, though new cases are continuously reported around the world. Transmission is believed to mainly occur in healthcare settings through aerosolized particles. This study uses Quantitative Microbial Risk Assessment to develop a generalizable model that can assist with interpreting reported outbreak data or predict risk of infection with or without the recommended strategies. The exposure scenario includes a single index patient emitting virus-containing aerosols into the air by coughing, leading to short- and long-range airborne exposures for other patients in the same room, nurses, healthcare workers, and family visitors. Aerosol transport modeling was coupled with Monte Carlo simulation to evaluate the risk of MERS illness for the exposed population. Results from a typical scenario show the daily mean risk of infection to be the highest for the nurses and healthcare workers (8.49 × 10-4 and 7.91 × 10-4 , respectively), and the lowest for family visitors and patients staying in the same room (3.12 × 10-4 and 1.29 × 10-4 , respectively). Sensitivity analysis indicates that more than 90% of the uncertainty in the risk characterization is due to the viral concentration in saliva. Assessment of risk interventions showed that respiratory masks were found to have a greater effect in reducing the risks for all the groups evaluated (>90% risk reduction), while increasing the air exchange was effective for the other patients in the same room only (up to 58% risk reduction).
© 2019 Society for Risk Analysis.
KEYWORDS: Hospital; MERS-CoV; QMRA; mitigation; risk characterization
PMID: 31524301 DOI: 10.1111/risa.13389