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Concept: Reassortment

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The CDC recommends that healthcare settings provide influenza patients with facemasks as a means of reducing transmission to staff and other patients, and a recent report suggested that surgical masks can capture influenza virus in large droplet spray. However, there is minimal data on influenza virus aerosol shedding, the infectiousness of exhaled aerosols, and none on the impact of facemasks on viral aerosol shedding from patients with seasonal influenza. We collected samples of exhaled particles (one with and one without a facemask) in two size fractions (“coarse”>5 µm, “fine"≤5 µm) from 37 volunteers within 5 days of seasonal influenza onset, measured viral copy number using quantitative RT-PCR, and tested the fine-particle fraction for culturable virus. Fine particles contained 8.8 (95% CI 4.1 to 19) fold more viral copies than did coarse particles. Surgical masks reduced viral copy numbers in the fine fraction by 2.8 fold (95% CI 1.5 to 5.2) and in the coarse fraction by 25 fold (95% CI 3.5 to 180). Overall, masks produced a 3.4 fold (95% CI 1.8 to 6.3) reduction in viral aerosol shedding. Correlations between nasopharyngeal swab and the aerosol fraction copy numbers were weak (r = 0.17, coarse; r = 0.29, fine fraction). Copy numbers in exhaled breath declined rapidly with day after onset of illness. Two subjects with the highest copy numbers gave culture positive fine particle samples. Surgical masks worn by patients reduce aerosols shedding of virus. The abundance of viral copies in fine particle aerosols and evidence for their infectiousness suggests an important role in seasonal influenza transmission. Monitoring exhaled virus aerosols will be important for validation of experimental transmission studies in humans.

Concepts: Influenza, Number, Part, Particulate, Aerosol, Particulates, Reassortment, Global dimming

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Self-collection of nasal swabs could improve the timeliness of influenza virus detection in older adults.

Concepts: Virus, Influenza, Reassortment

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ABSTRACT The voluntary moratorium on gain-of-function research related to the transmissibility of highly pathogenic H5N1 influenza virus should continue, pending the resolution of critical policy questions concerning the rationale for performing such experiments and how best to report their results. The potential benefits and risks of these experiments must be discussed and understood by multiple stakeholders, including the general public, and all decisions regarding such research must be made in a transparent manner.

Concepts: Microbiology, Influenza, Avian influenza, Transmission and infection of H5N1, Influenza A virus subtype H5N1, Public, Reassortment

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BACKGROUND: Most surgical masks are not certified for use as respiratory protective devices (RPDs). In the event of an influenza pandemic, logistical and practical implications such as storage and fit testing will restrict the use of RPDs to certain high-risk procedures that are likely to generate large amounts of infectious bioaerosols. Studies have shown that in such circumstances increased numbers of surgical masks are worn, but the protection afforded to the wearer by a surgical mask against infectious aerosols is not well understood. AIM: To develop and apply a method for assessing the protection afforded by surgical masks against a bioaerosol challenge. METHODS: A dummy test head attached to a breathing simulator was used to test the performance of surgical masks against a viral challenge. Several designs of surgical masks commonly used in the UK healthcare sector were evaluated by measuring levels of inert particles and live aerosolised influenza virus in the air, from in front of and behind each mask. FINDINGS: Live influenza virus was measurable from the air behind all surgical masks tested. The data indicate that a surgical mask will reduce exposure to aerosolised infectious influenza virus; reductions ranged from 1.1- to 55-fold (average 6-fold), depending on the design of the mask. CONCLUSION: We describe a workable method to evaluate the protective efficacy of surgical masks and RPDs against a relevant aerosolised biological challenge. The results demonstrated limitations of surgical masks in this context, although they are to some extent protective.

Concepts: Infectious disease, Influenza, Avian influenza, Influenza pandemic, Pandemic, Reassortment, Masks, Bioaerosol

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Despite annual co-circulation of different subtypes of seasonal influenza, co-infections between different viruses are rarely detected. These co-infections can result in the emergence of reassortant progeny.

Concepts: Microbiology, Virus, Antiviral drug, Influenza, Avian influenza, Virology, Reassortment, Computer virus

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Low pathogenic H7N9 influenza viruses have recently evolved to become highly pathogenic, raising concerns of a pandemic, particularly if these viruses acquire efficient human-to-human transmissibility. We compared a low pathogenic H7N9 virus with a highly pathogenic isolate, and two of its variants that represent neuraminidase inhibitor-sensitive and -resistant subpopulations detected within the isolate. The highly pathogenic H7N9 viruses replicated efficiently in mice, ferrets, and/or nonhuman primates, and were more pathogenic in mice and ferrets than the low pathogenic H7N9 virus, with the exception of the neuraminidase inhibitor-resistant virus, which showed mild-to-moderate attenuation. All viruses transmitted among ferrets via respiratory droplets, and the neuraminidase-sensitive variant killed several of the infected and exposed animals. Neuraminidase inhibitors showed limited effectiveness against these viruses in vivo, but the viruses were susceptible to a polymerase inhibitor. These results suggest that the highly pathogenic H7N9 virus has pandemic potential and should be closely monitored.

Concepts: DNA, Microbiology, Virus, Influenza, Avian influenza, Influenza pandemic, Neuraminidase, Reassortment

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We evaluated the limits of detection of 3 rapid influenza diagnostic tests-BD Veritor™ System for Flu A+B, Binax NOW® Influenza A+B, and QuickVue® Influenza-for influenza strains circulating in 2010-2012. Limits of detection varied by influenza strain, with Veritor™ Flu A+B test showing the lowest limit of detection for all strains.

Concepts: Virus, Antiviral drug, Influenza, Avian influenza, Strain, Orthomyxoviridae, Influenzavirus B, Reassortment

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Experimental studies in guinea pigs demonstrated that influenza virus transmission is strongly modulated by temperature and humidity. A number of epidemiological studies have followed up on these findings and revealed robust associations between influenza incidence in temperate regions and local conditions of humidity and temperature, offering a long-awaited explanation for the wintertime seasonality of influenza in these locales. Despite recent progress, important questions remain as to the mechanism(s) by which humidity and/or temperature affect transmission.

Concepts: Epidemiology, Climate, Influenza, Arctic Circle, Reassortment, Temperateness, Ubuntu, Locale

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Eurasian (EA)-origin H5N8 clade 2.3.4.4 avian influenza viruses were first detected in North America during December 2014. Subsequent reassortment with North American (AM) low-pathogenic wild-bird-origin avian influenza has generated at least two reassortants, including an EA/AM H5N1 from an apparently healthy wild green-winged teal, suggesting continued ongoing reassortment.

Concepts: Microbiology, Virus, United States, Influenza, Avian influenza, Influenza pandemic, North America, Reassortment

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Avian A/H5N1 influenza viruses pose a pandemic threat. As few as five amino acid substitutions, or four with reassortment, might be sufficient for mammal-to-mammal transmission through respiratory droplets. From surveillance data, we found that two of these substitutions are common in A/H5N1 viruses, and thus, some viruses might require only three additional substitutions to become transmissible via respiratory droplets between mammals. We used a mathematical model of within-host virus evolution to study factors that could increase and decrease the probability of the remaining substitutions evolving after the virus has infected a mammalian host. These factors, combined with the presence of some of these substitutions in circulating strains, make a virus evolving in nature a potentially serious threat. These results highlight critical areas in which more data are needed for assessing, and potentially averting, this threat.

Concepts: Evolution, Microbiology, Virus, Influenza, Avian influenza, Influenza pandemic, Virology, Reassortment