Effect of route of inoculation on experimental respiratory viral disease in volunteers and evidence for airborne transmission

INTRODUCTION Initiation of respiratory viral infection, with some possible exceptions, appears to depend upon deposition of infectious virus at some point on the respiratory tract. There appear to be two possible mechanisms of transmission, contact or airborne. The former term is meant to refer to transfer of virus by physical contact between an infected and a susceptible subject, or indirectly through personal articles or fomites. Transmission by this route would result in deposition of virus predominantly in the nasopharynx. Airborne transmission is intended to mean transfer of infection by means of small-particle aerosols (11, 16). These particles are the evaporated residues of infected respiratory secretions which are of such small size (mostly less than 5 .t in diameter) that they will remain airborne for long periods of time. As a function of their small size, such droplets, when inhaled, 1 Present address: Baylor University College of Medicine, Houston, Tex. 2Present address: Washington University College of Medicine, St. Louis, Mo. deposit predominantly in the lower respiratory tract. Particles between 5 and 15 1A to 20 1i in diameter represent an intermediate stage, and most particles in this size range will be trapped in the nose, although some will penetrate to below the larynx. (Lower respiratory tract will refer to that portion of the respiratory tract below the larynx.) Still larger particles may be produced by coughing and sneezing, etc., but since, because of their large size, they do not produce stable aerosols, transmission will ordinarily occur only by direct impaction on the nasopharynx of persons in the immediate vicinity of an infected case. Such transmission would be difficult to distinguish from that resulting from contact, and is best considered under this category. This report will describe studies of the transmission of respiratory viral diseases which were a joint undertaking of the U.S. Army Biological Laboratories, Fort Detrick, Md., and the Laboratory of Clinical Investigations, National Institute of Allergy and Infectious Diseases, Bethesda, Md.

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