Aerosolization of a Human Norovirus Surrogate, Bacteriophage MS2, during Simulated Vomiting.
Human noroviruses (NoV) are the leading cause of acute gastroenteritis worldwide. Epidemiological studies of outbreaks have suggested that vomiting facilitates transmission of human NoV, but there have been no laboratory-based studies characterizing the degree of NoV release during a vomiting event. The purpose of this work was to demonstrate that virus aerosolization occurs in a simulated vomiting event, and to estimate the amount of virus that is released in those aerosols. A simulated vomiting device was constructed at one-quarter scale of the human body following similitude principles. Simulated vomitus matrices at low (6.24 mPa*s) and high (177.5 mPa*s) viscosities were inoculated with low (108 PFU/mL) and high (1010 PFU/mL) concentrations of bacteriophage MS2 and placed in the artificial "stomach" of the device, which was then subjected to scaled physiologically relevant pressures associated with vomiting. Bio aerosols were captured using an SKC Biosampler. In low viscosity artificial vomitus, there were notable differences between recovered aerosolized MS2 as a function of pressure (i.e., greater aerosolization with increased pressure), although this was not always statistically significant. This relationship disappeared when using high viscosity simulated vomitus. The amount of MS2 aerosolized as a percent of total virus "vomited" ranged from 7.2 x 10-5 to 2.67 x 10-2 (which corresponded to a range of 36 to 13,350 PFU total). To our knowledge, this is the first study to document and measure aerosolization of a NoV surrogate in a similitude-based physical model. This has implications for better understanding the transmission dynamics of human NoV and for risk modeling purposes, both of which can help in designing effective infection control measures.
Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, North Carolina, United States of America.
Grace
G
Tung-Thompson
Department of Civil, Construction and Environmental Engineering, North Carolina State University, Raleigh, North Carolina, United States of America.
Dominic A
DA
Libera
Section on Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, United States of America.
Kenneth L
KL
Koch
Department of Civil, Construction and Environmental Engineering, North Carolina State University, Raleigh, North Carolina, United States of America.
Francis L
FL
de Los Reyes
Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, North Carolina, United States of America.
Lee-Ann
LA
Jaykus
D000336:Aerosols / Q000032:analysis*; D017250:Caliciviridae Infections / Q000150:complications* / Q000635:transmission* / Q000821:virology; D004196:Disease Outbreaks; D005759:Gastroenteritis / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D017909:Levivirus / Q000302:isolation & purification*; D008954:Models, Biological; D029322:Norovirus / Q000302:isolation & purification*; D014839:Vomiting / Q000150:complications / Q000821:virology*
D000336:Aerosols