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Curr Opin Virol. 2017 Feb;22:22-29. doi: 10.1016/j.coviro.2016.11.006. Epub 2016 Dec 2.

Drivers of airborne human-to-human pathogen transmission.

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Department of Viroscience, Postgraduate School of Molecular Medicine, Erasmus MC, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands. Electronic address:
Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 96a, 07743 Jena, Germany.
Robert Koch Institut, Department for Infectious Disease Epidemiology, Seestr. 10, 13353 Berlin, Germany; PhD Programme "Epidemiology", Braunschweig-Hannover, Germany.
Université de Lyon, UMRS 449, Laboratoire de Biologie Générale, Université Catholique de Lyon - EPHE, Lyon 69288, France; Molecular Basis of Viral Pathogenicity, International Centre for Research in Infectiology (CIRI), INSERM U1111 - CNRS UMR5308, Université Lyon 1, Ecole Normale Supérieure de Lyon, Lyon 69007, France.
Centre for Pathogen Evolution, Department of Zoology, University of Cambridge, Downing Street, Cambridge, United Kingdom.
Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544, USA.
Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA.
Department of Viroscience, Postgraduate School of Molecular Medicine, Erasmus MC, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
Friedrich-Loeffler-Institut, Institute of Molecular Pathogenesis, Naumburger Str. 96a, 07743 Jena, Germany.


Airborne pathogens - either transmitted via aerosol or droplets - include a wide variety of highly infectious and dangerous microbes such as variola virus, measles virus, influenza A viruses, Mycobacterium tuberculosis, Streptococcus pneumoniae, and Bordetella pertussis. Emerging zoonotic pathogens, for example, MERS coronavirus, avian influenza viruses, Coxiella, and Francisella, would have pandemic potential were they to acquire efficient human-to-human transmissibility. Here, we synthesize insights from microbiological, medical, social, and economic sciences to provide known mechanisms of aerosolized transmissibility and identify knowledge gaps that limit emergency preparedness plans. In particular, we propose a framework of drivers facilitating human-to-human transmission with the airspace between individuals as an intermediate stage. The model is expected to enhance identification and risk assessment of novel pathogens.

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