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Quantity and size distribution of cough-generated aerosol particles produced by influenza patients during and after illness.

Lindsley WG; Pearce TA; Hudnall JB; Davis KA; Davis SM; Fisher MA; Khakoo R; Palmer JE; Clark KE; Celik I; Coffey CC; Blachere FM; Beezhold DH
J Occup Environ Hyg 2012 Jul; 9(7):443-449
The question of whether influenza is transmitted to a significant degree by aerosols remains controversial, in part, because little is known about the quantity and size of potentially infectious airborne particles produced by people with influenza. In this study, the size and amount of aerosol particles produced by nine subjects during coughing were measured while they had influenza and after they had recovered, using a laser aerosol particle spectrometer with a size range of 0.35 to 10 µm. Individuals with influenza produce a significantly greater volume of aerosol when ill compared with afterward (p = 0.0143). When the patients had influenza, their average cough aerosol volume was 38.3 picoliters (pL) of particles per cough (SD 43.7); after patients recovered, the average volume was 26.4 pL per cough (SD 45.6). The number of particles produced per cough was also higher when subjects had influenza (average 75,400 particles/cough, SD 97,300) compared with afterward (average 52,200, SD 98,600), although the difference did not reach statistical significance (p = 0.1042). The average number of particles expelled per cough varied widely from patient to patient, ranging from 900 to 302,200 particles/cough while subjects had influenza and 1100 to 308,600 particles/cough after recovery. When the subjects had influenza, an average of 63% of each subject's cough aerosol particle volume in the detection range was in the respirable size fraction (SD 22%), indicating that these particles could reach the alveolar region of the lungs if inhaled by another person. This enhancement in aerosol generation during illness may play an important role in influenza transmission and suggests that a better understanding of this phenomenon is needed to predict the production and dissemination of influenza-laden aerosols by people infected with this virus. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resources: a PDF file of demographic information, influenza test results, and volume and peak flow rate during each cough <a href=""target="_blank"></a> and a PDF file containing number and size of aerosol particles produced <a href=""target="_blank"></a>.].
Aerosols; Airborne-particles; Diseases; Disease-transmission; Particulates; Respiratory-infections; Respiration; Respiratory-system-disorders; Pulmonary-system-disorders; Pulmonary-function; Pulmonary-congestion; Infectious-diseases; Author Keywords: airborne particles; airborne transmission; disease transmission human; respiratory infections
William G. Lindsley, National Institute for Occupational Safety and Health, Health Effects Laboratory Division, 1095 Willowdale Road, M/S 4020, Morgantown, WV 26505-2845
Publication Date
Document Type
Journal Article
Email Address
Funding Type
Fiscal Year
Identifying No.
Grant-Number-T01-OH-008431; B06202012
Issue of Publication
NIOSH Division
Priority Area
Healthcare and Social Assistance
Source Name
Journal of Occupational and Environmental Hygiene
Performing Organization
West Virginia University
Page last reviewed: September 3, 2021
Content source: National Institute for Occupational Safety and Health Education and Information Division