title: Role of mechanical ventilation in the airborne transmission of infectious agents in buildings.
abstract: Infectious disease outbreaks and epidemics such as those due to SARS, influenza, measles, tuberculosis, and Middle East respiratory syndrome coronavirus have raised concern about the airborne transmission of pathogens in indoor environments. Significant gaps in knowledge still exist regarding the role of mechanical ventilation in airborne pathogen transmission. This review, prepared by a multidisciplinary group of researchers, focuses on summarizing the strengths and limitations of epidemiologic studies that specifically addressed the association of at least one heating, ventilating and/or air-conditioning (HVAC) system-related parameter with airborne disease transmission in buildings. The purpose of this literature review was to assess the quality and quantity of available data and to identify research needs. This review suggests that there is a need for well-designed observational and intervention studies in buildings with better HVAC system characterization and measurements of both airborne exposures and disease outcomes. Studies should also be designed so that they may be used in future quantitative meta-analyses.
authors.affiliation: Department of Mechanical Engineering, University of Colorado, Boulder, CO, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Luongo
authors.affiliation: Division of Infectious Diseases and Global Medicine, Emerging Pathogens Institute, College of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: K P
authors.initials: KP
authors.lastname: Fennelly
authors.affiliation: Department of Architectural Engineering and Construction Science, Kansas State University, Manhattan, KS, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Keen
authors.affiliation: Department of Civil, Environmental, and Architectural Engineering, University of Colorado, Boulder, CO, USA.
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Zhai
authors.affiliation: Department of Mechanical and Nuclear Engineering, Kansas State University, Manhattan, KS, USA.
authors.forename: B W
authors.initials: BW
authors.lastname: Jones
authors.affiliation: Department of Mechanical Engineering, University of Colorado, Boulder, CO, USA. Shelly.Miller@colorado.edu.
authors.forename: S L
authors.initials: SL
authors.lastname: Miller
mesh_terms: D000389:Air Conditioning / Q000009:adverse effects*; D016902:Air Pollution, Indoor / Q000032:analysis*; D018562:Disease Transmission, Infectious; D006801:Humans; D012107:Research Design; D014691:Ventilation
keywords: Airborne diseases; Airborne pathogen transmission; Epidemiology; Heating; Ventilating and/or air-conditioning; Ventilation rates; Ventilation systems