Gold T Louis, McPhaul Kathleen M, Lin Huang, Doughty Ryan, Berry Irina Maljkovic, Hong Filbert, Lai Jianyu, Treangen Todd J, Srebric Jelena, Milton Donald K
Department of Global, Environmental, and Occupational Health, University of Maryland School of Public Health, College Park, Maryland, USA.
Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA.
Influenza Other Respir Viruses. 2025 Jul;19(7):e70133. doi: 10.1111/irv.70133.
The SARS-CoV-2 pandemic focused attention on airborne-inhalation transmission and building ventilation. However, investment in solutions lags because few epidemiologic studies demonstrate a causal effect of ventilation on acute respiratory infection (ARI) transmission. This highlights a need for improved study designs to support causal inference.
To investigate the potential for causal inference, we analyzed prospective cohorts residing in a high-ventilation (HVent, ≥ 5 L/s per person) or a neighboring low-ventilation (LVent, < 5 L/s per person) college residence hall during two spring semesters (2018 and 2019). Swab samples, analyzed using a PCR panel for respiratory pathogens, were collected based on self-reported symptoms and contacts. Our analysis focused on roommate pairs where both had been tested within a 2-week period. Roommate pairs with concordant positive PCR results were categorized as possible transmission events. We used genetic sequencing and phylogenetic analysis to identify probable transmission clusters and events.
We analyzed data from 368 cohort participants (82 HVent and 286 LVent), including 60 person-infections, with a trend toward 54% lower ARI risk among students living in HVent versus LVent residence halls. We identified 97 roommate pairs, 64 two-week intervals where both members were tested, 36 (2 HVent and 34 LVent) intervals with ≥ 1 infection, and four possible transmission events (all LVent). Sequence data available for two of the four events confirmed one probable transmission cluster and one probable transmission event.
Future college dorm transmission studies should prioritize enrolling roommates rather than individuals, measuring ventilation, and confirming transmission events through whole genome sequencing.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行使人们将注意力集中在空气传播-吸入传播和建筑通风上。然而，由于很少有流行病学研究证明通风对急性呼吸道感染（ARI）传播有因果效应，因此在解决方案上的投资滞后。这凸显了改进研究设计以支持因果推断的必要性。
为了研究因果推断的可能性，我们分析了在两个春季学期（2018年和2019年）居住在高通风（HVent，每人≥5升/秒）或相邻低通风（LVent，每人<5升/秒）的大学宿舍中的前瞻性队列。根据自我报告的症状和接触情况，采集拭子样本，使用针对呼吸道病原体的PCR检测板进行分析。我们的分析重点是在两周内都接受检测的室友对。PCR结果一致为阳性的室友对被归类为可能的传播事件。我们使用基因测序和系统发育分析来识别可能的传播集群和事件。
我们分析了368名队列参与者（82名HVent和286名LVent）的数据，包括60例人感染病例，居住在HVent宿舍的学生患ARI的风险比居住在LVent宿舍的学生低54%，呈下降趋势。我们确定了97对室友，其中64个两周间隔内两名成员都接受了检测，36个（2个HVent和34个LVent）间隔内有≥1例感染，以及4起可能的传播事件（均为LVent）。这4起事件中有2起的序列数据证实了1个可能的传播集群和1起可能的传播事件。
未来的大学宿舍传播研究应优先招募室友而非个体，测量通风情况，并通过全基因组测序确认传播事件。
