title: "Gesundheit!" sneezing, common colds, allergies, and Staphylococcus aureus dispersion.
abstract: BACKGROUND
  Staphylococcus aureus is among the most important pathogens in today's hospital setting.
  
  
  METHODS
  The effects of sneezing on the airborne dispersal of S. aureus and other bacteria were assessed in 11 healthy nasal S. aureus carriers with experimentally induced rhinovirus colds. Airborne dispersal was studied by volumetric air sampling in 2 chamber sessions with and without histamine-induced sneezing. After 2 days of preexposure measurements, volunteers were inoculated with a rhinovirus and monitored for 14 days. Daily quantitative nasal- and skin-culture samples for bacteria and nasal-culture samples for rhinovirus were obtained, cold symptoms were assessed, and volunteer activities were recorded during sessions.
  
  
  RESULTS
  All participants developed a cold. Sneezing caused a 4.7-fold increase in the airborne dispersal of S. aureus, a 1.4-fold increase in coagulase-negative staphylococci (CoNS), and a 3.9-fold increase in other bacteria (P < .001). An additional 2.83 colony forming units (cfu) of S. aureus/m3/min, 3.24 cfu of CoNS/m3/min, and 474.61 cfu of other bacteria/m3/min were released per sneeze. Rhinovirus exposure did not change the frequency of sneezing or airborne dispersal. Having respiratory allergies increased the spread of S. aureus by 3.8-fold during sneezing sessions (P < .001).
  
  
  CONCLUSIONS
  Nasal S. aureus carriers disperse a significant amount of S. aureus into the air by sneezing. Experimental colds do not alter bacterial dispersal, but respiratory allergies multiply the effect of dispersing S. aureus.
authors.affiliation: Department of Internal Medicine, Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1042, USA. wbischof@wfubmc.edu
authors.forename: Werner E
authors.initials: WE
authors.lastname: Bischoff
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Wallis
authors.forename: Brian K
authors.initials: BK
authors.lastname: Tucker
authors.forename: Beth A
authors.initials: BA
authors.lastname: Reboussin
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pfaller
authors.forename: Frederick G
authors.initials: FG
authors.lastname: Hayden
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sherertz
mesh_terms: D000328:Adult; D000391:Air Microbiology; D002353:Carrier State / Q000382:microbiology; D016022:Case-Control Studies; D003139:Common Cold / Q000382:microbiology; D018562:Disease Transmission, Infectious; D005260:Female; D006801:Humans; D008297:Male; D009297:Nasal Mucosa / Q000382:microbiology; D006255:Rhinitis, Allergic, Seasonal / Q000382:microbiology; D012912:Sneezing; D013203:Staphylococcal Infections / Q000382:microbiology / Q000635:transmission*; D013211:Staphylococcus aureus / Q000302:isolation & purification* / Q000472:pathogenicity