ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2023
Exhaled Breath Aerosol Shedding of Highly Transmissible Versus Prior Severe Acute Respiratory Syndrome Coronavirus 2 Variants.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Severe acute respiratory syndrome coronavirus-2 shedding in exhaled material: a systematic review.Epidemiology and infection · 2025Pooled it
- Host factors associated with respiratory particle emission and virus presence within respiratory particles: a systematic review.Frontiers in microbiology · 2025Pooled it
- Non-pharmaceutical interventions for COVID-19: a systematic review on environmental control measures.Philosophical transactions. Series A, Mathematical, physical, and engineering sciences · 2023Pooled it
- Accounting for the long-distance transmission route: An epidemiological model of airborne disease transmission in hospitals.PLoS computational biology · 2026Article
- Loss of Infectivity of Influenza Virus and SARS-CoV‑2 during Aerosol Sampling.Environmental science & technology letters · 2026Article
- Heterogeneity of Airborne Virus Transmission in the Built Environment: A Narrative Review.Pathogens & immunity · 2026Review
- Evaluating modes of influenza transmission (EMIT-2): Insights from lack of transmission in a controlled transmission trial with naturally infected donors.PLoS pathogens · 2026Article
- Understanding Aerosol-Mediated Disease Transmission.ACS central science · 2025Review
- Evaluating Modes of Influenza Transmission (EMIT-2): Insights from a Controlled Human Influenza Virus Infection Transmission Trial (CHIVITT).medRxiv : the preprint server for health sciences · 2025Article
- The impact of temperature and relative humidity on SARS-CoV-2 airborne transmission in Syrian hamsters.Microbiology spectrum · 2025Article
- SARS-CoV-2 variants retain high airborne transmissibility by different strategies.Npj viruses · 2025Article
- Variant-Specific Interactions at the Plasma Membrane: Heparan Sulfate's Impact on SARS-CoV-2 Binding Kinetics.Analytical chemistry · 2025Article
- Occupational exposure monitoring of airborne respiratory viruses in outpatient medical clinics.Aerosol science and technology : the journal of the American Association for Aerosol Research · 2024Article
- Article
- Reducing Transmission of Airborne Respiratory Pathogens: A New Beginning as the COVID-19 Emergency Ends.Environmental health perspectives · 2024Review
- Five discoveries about COVID-19 made since the public health emergency ended.Nature medicine · 2023Article
- Infectivity of exhaled SARS-CoV-2 aerosols is sufficient to transmit covid-19 within minutes.Scientific reports · 2023Article
- Detection of SARS-CoV-2 RNA in exhaled breath and its potential for prevention measures.Infection prevention in practice · 2023Article
- Transmission and infection risk of COVID-19 when people coughing in an elevator.Building and environment · 2023Article
- Risk factors and vectors for SARS-CoV-2 household transmission: a prospective, longitudinal cohort study.The Lancet. Microbe · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors.
Funding
Abstract
backgroundAerosol inhalation is recognized as the dominant mode of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Three highly transmissible lineages evolved during the pandemic. One hypothesis to explain increased transmissibility is that natural selection favors variants with higher rates of viral aerosol shedding. However, the extent of aerosol shedding of successive SARS-CoV-2 variants is unknown. We aimed to measure the infectivity and rate of SARS-CoV-2 shedding into exhaled breath aerosol (EBA) by individuals during the Delta and Omicron waves and compared those rates with those of prior SARS-CoV-2 variants from our previously published work.
methodsIndividuals with coronavirus disease 2019 (COVID-19) (n = 93; 32 vaccinated and 20 boosted) were recruited to give samples, including 30-minute breath samples into a Gesundheit-II EBA sampler. Samples were quantified for viral RNA using reverse-transcription polymerase chain reaction and cultured for virus.
resultsAlpha (n = 4), Delta (n = 3), and Omicron (n = 29) cases shed significantly more viral RNA copies into EBAs than cases infected with ancestral strains and variants not associated with increased transmissibility (n = 57). All Delta and Omicron cases were fully vaccinated and most Omicron cases were boosted. We cultured virus from the EBA of 1 boosted and 3 fully vaccinated cases.
conclusionsAlpha, Delta, and Omicron independently evolved high viral aerosol shedding phenotypes, demonstrating convergent evolution. Vaccinated and boosted cases can shed infectious SARS-CoV-2 via EBA. These findings support a dominant role of infectious aerosols in transmission of SARS-CoV-2. Monitoring aerosol shedding from new variants and emerging pathogens can be an important component of future threat assessments and guide interventions to prevent transmission.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.