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15 October 2006

Volume 194, Number 8
The Journal of Infectious Diseases 2006;194:1119–1126
© 2006 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2006/19408-0013$15.00
DOI: 10.1086/507908
MAJOR ARTICLE

“Gesundheit!” Sneezing, Common Colds, Allergies, and Staphylococcus aureus Dispersion

Werner E. Bischoff,1

Michelle L. Wallis,1

Brian K. Tucker,1

Beth A. Reboussin,2

Michael A. Pfaller,3

Frederick G. Hayden,4 and

Robert J. Sherertz1

1Department of Internal Medicine, Section on Infectious Diseases and 2Section on Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina; 3Medical Microbiology Division, The University of Iowa Hospitals and Clinics, Iowa City; 4Division of Infectious Diseases and International Health, University of Virginia Health Sciences Center, Charlottesville

Background.  Staphylococcus aureus is among the most important pathogens in today's hospital setting.

Methods.  The effects of sneezing on the airborne dispersal of S. aureus and other bacteria were assessed in 11 healthy nasal S. aureus carriers with experimentally induced rhinovirus colds. Airborne dispersal was studied by volumetric air sampling in 2 chamber sessions with and without histamine-induced sneezing. After 2 days of preexposure measurements, volunteers were inoculated with a rhinovirus and monitored for 14 days. Daily quantitative nasal- and skin-culture samples for bacteria and nasal-culture samples for rhinovirus were obtained, cold symptoms were assessed, and volunteer activities were recorded during sessions.

Results.  All participants developed a cold. Sneezing caused a 4.7-fold increase in the airborne dispersal of S. aureus, a 1.4-fold increase in coagulase-negative staphylococci (CoNS), and a 3.9-fold increase in other bacteria ( ). An additional 2.83 colony forming units (cfu) of S. aureus/m3/min, 3.24 cfu of CoNS/m3/min, and 474.61 cfu of other bacteria/m3/min were released per sneeze. Rhinovirus exposure did not change the frequency of sneezing or airborne dispersal. Having respiratory allergies increased the spread of S. aureus by 3.8-fold during sneezing sessions ( ).

Conclusion.  Nasal S. aureus carriers disperse a significant amount of S. aureus into the air by sneezing. Experimental colds do not alter bacterial dispersal, but respiratory allergies multiply the effect of dispersing S. aureus.

Received 3 March 2006; accepted 22 June 2006; electronically published 11 September 2006.

  • Presented in part: 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, 27–30 September 2002 (abstract K-457).

    Financial support: National Institutes of Health (grant 1R01AI46558-01A1 for the “Cloud Adult” study).

    Potential conflicts of interest: none reported.

Reprints or correspondence: Dr. Werner E. Bischoff, Wake Forest University School of Medicine, Dept. of Internal Medicine, Section on Infectious Diseases, Medical Center Blvd., Winston-Salem, NC 27157-1042 ()
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