Concentrations and size distributions of airborne influenza A viruses measured indoors at a health centre, a day-care centre and on aeroplanes

The relative importance of the aerosol transmission route for influenza remains contentious. To determine the potential for influenza to spread via the aerosol route, we measured the size distribution of airborne influenza A viruses. We collected size-segregated aerosol samples during the 2009-2010 flu season in a health centre, a day-care facility and onboard aeroplanes. Filter extracts were analysed using quantitative reverse transcriptase polymerase chain reaction. Half of the 16 samples were positive, and their total virus concentrations ranged from 5800 to 37 000 genome copies m(-3). On average, 64 per cent of the viral genome copies were associated with fine particles smaller than 2.5 mu m, which can remain suspended for hours. Modelling of virus concentrations indoors suggested a source strength of 1.6 +/- 1.2 x 10(5) genome copies m(-3) air h(-1) and a deposition flux onto surfaces of 13 +/- 7 genome copies m(-2) h(-1) by Brownian motion. Over 1 hour, the inhalation dose was estimated to be 30 +/- 18 median tissue culture infectious dose (TCID(50)), adequate to induce infection. These results provide quantitative support for the idea that the aerosol route could be an important mode of influenza transmission.