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Influenza Transmission Workshop, November 2010

Workshop Agenda

Dates: November 4-5, 2010

Location: CDC Roybal Campus, Auditorium B1/B2, Atlanta, GA

Purposes: To review state of the art science in influenza transmission, to identify gaps in understanding the modes of influenza transmission, and to identify the best approaches to understand influenza transmission and resolve continuing questions about the relative contributions of contact, droplet, and airborne transmission of influenza in humans.

Schedule:
Shuttle leaves Holiday Inn Conference Center at 7:30 AM.
Day 1: Registration at 8:00-8:30
8:30-9:00

Welcome: Steve Redd, Director, CDC Influenza Coordination Unit, John Decker, Senior Scientist, Office of the Director, NIOSH, and Nancy Cox, Director, Influenza Division, NCIRD.

Background for meeting and CDC scientific agenda projects regarding influenza transmission: Dixie Snider, CDC/OD and David Weissman, NIOSH, CDC.

Charge to attendees: Carolyn Bridges, NCIRD, CDC

9:00

Plenary Session I

9:00 – 9:30 Molecular determinants and strain variability in influenza transmission/ virus pathogen factors that may influence transmission - Terry Tumpey, NCIRD, CDC Atlanta

9:30 – 10:15 Assessing influenza virus levels and determinants of influenza virus survival on surfaces – Judith Noble-Wang, Angela Coulliette, and Kate Ellingson, NCEZID, CDC Atlanta

Break 10:15 – 10:30

10:30 – 11:00 Influenza aerobiology, including variability among hosts/host factors that may contribute to influenza transmission through the air – Don Milton, University of Maryland

11:00 – 11:30 Lessons from animal models regarding relative contribution of different modes of transmission and impact of temperature and humidity – Peter Palese, Mt. Sinai Medical Center

11:30 – 12:00 Environmental factors (e.g. temperature and humidity) that may affect the modes and/or efficiency of transmission among people – Jeffery Shaman, Oregon State University

Lunch Break 12:00-1:00

Plenary Session II 1:00-3:00

1:00 - 1:30 Summary of epidemiological and outbreak investigations that provide information on influenza transmission – Ben Killingley, University of Nottingham, UK

1:30 – 2:00 Community Intervention Studies – hand washing, face masks – Ben Cowling, University of Hong Kong, Hong Kong SAR, China

2:00 - 2:30 Investigations of respiratory protection in health care settings – Mark Loeb, McMaster University, Canada

2:30 – 3:00 Investigation of respiratory protection from an industrial hygiene perspective - Howard Cohen, Yale University School of Medicine and Dept. of Occupational and Environmental Health

Break 3:00 – 3:15

Plenary Session III 3:15-5:15

3:15 – 3:45 Investigations of Environmental Controls (ventilation, UV, temperature, humidity, etc) - Implementation in buildings & workplaces - Mark Hernandez, University of Colorado

3:45 – 4:15 Use of human challenge studies and human exposure studies to ascertain modes of influenza transmission and transmission of other respiratory viruses. – Jonathan van Tam, University of Nottingham, UK

4:15 – 4:45 What influenza antiviral clinical trials may tell us about modes of influenza transmission – Fred Hayden, University of Virginia and Wellcome Trust

4:45 – 5:15 What do modeling studies suggest regarding modes of influenza transmission and how might better information on modes of transmission improve models? – Mark Nicas, UC Berkeley

5:15 – 5:30 Wrap up from days discussions.

5:30 – Shuttle leaves for Holiday Inn Conference Center

6:30 Reception for meeting attendees at Holiday Inn Conference Center, Downtown Decatur

Day 2

Shuttle leaves Holiday Inn Conference Center at 7:30 AM

8:15 – 8:30 Questions remaining from Day 1

8:30 - 9:00 Information on HITS study, Thailand – Sonja Olsen, CDC, Bangkok, Thailand

9:00 – 9:30 Cairo study of the effects of hand washing on laboratory confirmed influenza in children – Maha Talaat, US Naval Medical Research Unit, No.3 (NAMRU-3) and Abbassia Fever Hospital, Abbassia, Cairo, Egypt

9:30 – 9:45 Wrap up from morning discussions and instructions to group for breakout sessions.

9:45 – 10:00 Break and proceed to breakout rooms

10:00 – 12:15 Break out Group Discussions

Breakout Group #1: Best methods for studying contact transmission – Group stays in main meeting room.

  • What are the key questions/gaps remaining in understanding contribution of contact transmission to spread of influenza?
    • Level of documentation of influenza transmission via contact transmission
    • Relative importance for transmission of influenza
    • Dose-infection relationships for, and relative importance of, potential target mucosal surfaces
    • Typical levels of surface contamination, how clean is clean enough to reduce spread via this route
    • Impact of environmental factors (temperature, humidity, ambient UV, etc) on influenza spread among humans via this route
    • Role of ventilation/air exchange via this route
    • Interventions or exposures that may isolate the role of droplets in the spread of influenza
  • What are scientific approaches to answer key questions that will lead to a better understanding of the relative contribution or role of contact transmission in the spread of influenza among people?
    • Include pros and cons of each study approach
  • How should temperature, humidity and air exchange be considered in study designs?

Breakout Group #2: Best methods for studying droplet transmission – room 116, building 19

  • What are the key questions/gaps remaining for understanding the role of droplet transmission in the spread of influenza in humans?
    • Level of documentation of transmission by large droplets; isolation of droplet transmission from transmission by droplet nuclei/aerosols
    • Relative importance for transmission of influenza
    • Typical numbers and levels of virus in droplets
    • Dose-infection relationships for this route of transmission relative to other routes
    • Relative importance of potential target mucosal surfaces via droplet transmission
    • Distance over which droplet transmission may occur
    • Impact of environmental factors (temperature, humidity, ambient UV, etc) on influenza spread among humans via this route
    • Host factors that may increase or decrease transmission by droplet spread
    • Interventions or exposures that isolated the role of large droplets in transmission
  • What are scientific approaches to answer the key questions that will lead to a better understanding of the relative contribution or role of droplet transmission in the spread of influenza among people?
    • Include pros and cons of each study approach
  • How should temperature, humidity and air exchange be considered in study designs?

Breakout Group #3: Best methods for studying airborne transmission – room 117 building 19

  • What are the key questions/gaps remaining for understanding the role of droplet nuclei/airborne transmission of influenza in humans?
    • Level of documentation of transmission via small particle aerosols
    • Dose-infection relationships
    • Duration of infectivity from aerosolized infectious particles
    • Evidence on distance (s) over which transmission can occur via this route
    • Impact of environmental factors (temperature, humidity, ambient UV, etc) on spread to humans via this route
    • Host factors that may increase or decrease transmission by droplet spread
    • Intervention or exposures that may isolate the role of droplet nuclei in the spread of influenza
    • How might changes in air exchange rate/ventilation mitigate transmission via this route
  • What are scientific approaches to answer key questions that will lead to a better understanding of the relative contribution or role of droplet nuclei/airborne transmission in the spread of influenza among people?
    • Include pros and cons of each study approach
  • How should temperature, humidity and air exchange be considered in study designs?

12:15 – 1:30 Break for lunch and group note takers and rapporteurs work on slides for afternoon session.

1:30 – 4:00

Presentations from break out groups.

Discussion of specific scientific approaches to better understand the relative contributions of different modes of influenza transmission.

1:30 – 4:00 Concluding discussions.

End meeting at 4:30 PM

Shuttle back to Holiday Inn Conference Center 4:45


 
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