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Transmission routes of respiratory viruses among humans
Open accessAbstract
Respiratory tract infections can be caused by a wide variety of viruses. Airborne transmission via droplets and aerosols enables some of these viruses to spread efficiently among humans, causing outbreaks that are difficult to control. Many outbreaks have been investigated retrospectively to study the possible routes of inter-human virus transmission. The results of these studies are often inconclusive and at the same time data from controlled experiments is sparse. Therefore, fundamental knowledge on transmission routes that could be used to improve intervention strategies is still missing. We here present an overview of the available data from experimental and observational studies on the transmission routes of respiratory viruses between humans, identify knowledge gaps, and discuss how the available knowledge is currently implemented in isolation guidelines in health care settings.
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“Physical interventions, such as the use of masks and physical distancing measures, might prevent the spread of respiratory viruses which are considered to be transmitted by multiple modes of transmission including by respiratory particles of varying sizes spreading from infected to susceptible people and through direct and indirect contact (Kutter 2018; Leung 2021).”
From Physical interventions to interrupt or reduce the spread of respiratory viruses (2023) · cites this paper as Kutter 2018
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“In addition, transmission of respiratory viruses is likely highly complex, dependent on multiple host, virus and environmental factors, plus the myriad of interactions between these factors, which may influence the predominant modes of transmission in any given setting (Broderick 2008; Hendley 1988; Kutter 2018; Leung 2021).”
From Physical interventions to interrupt or reduce the spread of respiratory viruses (2023) · cites this paper as Kutter 2018
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“Humans are infected by respiratory viruses that originate from the respiratory tract of other humans and are transmitted in respiratory mucus by aerosols generated by coughing and sneezing and by fomites such as commonly touched surfaces (15).”
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“Subsequently, these pathogens are transmitted mainly through the respiratory secretions of infected people by direct (physical) or indirect contact (contaminated objects or surfaces), as well as by droplets or aerosols [3,4].”
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BackgroundAerosol Transmission of Infectious Disease and the Efficacy of Personal Protective Equipment (PPE)
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Ullah, M. A., Islam, H., Rahman, A., Masud, J., Shweta, D. S., Araf, Y., Sium, S. M. A., & Sarkar, B. (2020) · Electronic Journal of General Medicine · doi:10.29333/ejgm/8258 · Cited by 26
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Shirvanimoghaddam, K., Czech, B., Yadav, R., Gokce, C., Fusco, L., Delogu, L. G., Yılmazer, A., Brodie, G. I., Al–Othman, A., Al-Tamimi, A. K., et al. (2022) · Sustainability · doi:10.3390/su14020737 · Cited by 28
“In contrast to the droplets, aerosols involve particle with a size <5 μ, which are reported to stay in the air for infinite time with the ability to disperse over longer distances (>1 m) [18].”
BackgroundSARS-CoV-2 and Dentistry–Review
Neto, C. L. D. M. M., Bannwart, L. C., Moreno, A. L. D. M., & Goiato, M. C. (2020) · European Journal of Dentistry · doi:10.1055/s-0040-1716438 · Cited by 27
Li, X., Wang, Q., Ding, P., Cha, Y., Mao, Y., Ding, C., Gu, W., Wang, Y., Ying, B., Zhao, X., et al. (2021) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2021.146040 · Cited by 27
“LTD, Qingdao, China) were placed at different distances and heights within 15 m of operation sites according to the droplet diffusion distances of larger droplets and aerosols, and each simulation scenario was collected 20 mins~2 h for the particles (droplets) precipitation in air (Kutter et al., 2018).”
Bangiyev, R., Chudaev, M., Schaffner, D. W., & Goldman, E. (2021) · Applied and Environmental Microbiology · doi:10.1128/aem.01371-21 · Cited by 27
“With the exception of Respiratory Syncytial virus, the belief that most, if not all, of these viruses can be spread by fomites is based solely on dried virus stability experiments (e.g. Kutter et al, 2018).”
BackgroundNon-COVID-19 respiratory viral infection
Silva, C., Vilares, A. T., Schweitzer, V. A., Castanhinha, S., Martins, A., Lopes, M. J., Bartoli, T. A., Canelas, G., Keir, H. R., Cunha, F., et al. (2022) · Breathe · doi:10.1183/20734735.0151-2021 · Cited by 28
Smart Mask as Wearable for Post-Pandemic Personal Healthcare
Li, J., Yin, J., Ramakrishna, S., & Ji, D. (2023) · Biosensors · doi:10.3390/bios13020205 · Cited by 29
“Larger droplets settle down easily due to gravity, while respiratory droplets and aerosols with a smaller size (<5 μm) carry and help viruses such as SARS-CoV-2 transmit [9].”
BackgroundA fluid mechanics explanation of the effectiveness of common materials for respiratory masks
Maher, B., Chavez, R., Tomaz, G. C. Q., Nguyen, T., & Hassan, Y. A. (2020) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2020.07.066 · Cited by 26
“…as the first personal protection during the COVID-19 pandemic because the transmission of the respiratory virus is mainly via human laden fluid particles, i.e., aerosols and droplets (Konda et al., 2020; Mittal et al., 2020; Kutter et al., 2018; Stelzer-Braid et al., 2009; Milton et al., 2013).”
Modeling and Experimental Validation of Microbial Transfer via Surface Touch
Zhao, P., & Li, Y. (2020) · Environmental Science & Technology · doi:10.1021/acs.est.0c04678 · Cited by 26
Maffei, M. E., Salata, C., & Gribaudo, G. (2022) · Molecules · doi:10.3390/molecules27238353 · Cited by 26
Hu, N., Feng, Y., Gram, A., Yao, R., & Sadrizadeh, S. (2023) · Building and Environment · doi:10.1016/j.buildenv.2023.110994 · Cited by 25
A comprehensive overview on the crosstalk between microRNAs and viral pathogenesis and infection
Mahdavi, S. Z. B., Jebelli, A., Aghbash, P. S., Baradaran, B., Amini, M., Oroojalian, F., Pouladi, N., Baghi, H. B., de la Guárdia, M., & Mokhtarzadeh, A. (2024) · Medicinal Research Reviews · doi:10.1002/med.22073 · Cited by 26
SARS-CoV-2 Seropositivity among Dental Staff and the Role of Aspirating Systems
Sarapultseva, M., Hu, D., & Sarapultsev, A. (2021) · JDR Clinical & Translational Research · doi:10.1177/2380084421993099 · Cited by 25
“Reportedly, 15-min treatment without protective measures can result in inhalation of approximately 0.014 to 0.12 µL of saliva via the aerosol (Bennett et al. 2000), which can travel beyond 6 feet and spread virus particles, as shown in cases of SARS-CoV-2 infection (Kutter et al. 2018).”
BackgroundMethodInfluentialda Silva, S. J. R., do Nascimento, J. C. F., Reis, W. P. M. D. S., da Silva, C. T. A., da Silva, P. G., Mendes, R. P. G., Mendonça, A. A., Santos, B. N. R., de Magalhães, J. J. F., Kohl, A., et al. (2021) · Environmental Microbiology · doi:10.1111/1462-2920.15855 · Cited by 25
“…has been found to have high person-toperson transmission through direct contact with infected individuals (Hu et al., 2021), especially by coughing, sneezing and even breathing/talking by an infected person (Tang et al., 2013; Kutter et al., 2018; Leung et al., 2020; Stadnytskyi et al., 2020).”
BackgroundBsoul, E. A., & Loomer, P. M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0264323 · Cited by 25
Zhang, Y., Hui, F. K. P., Duffield, C. F., & Saeed, A. M. (2022) · Building and Environment · doi:10.1016/j.buildenv.2022.109347 · Cited by 26
“and furniture and then spread to others who contact the contaminated surfaces afterwards [18,20,21].”
Si, Y., Wang, Y., Tian, Q., Wang, Q., Pollard, J. M., Srivastava, P. K., Esser-Kahn, A. P., Collier, J. H., Sperling, A. I., & Chong, A. S. (2023) · Cell Reports · doi:10.1016/j.celrep.2023.113299 · Cited by 26
“Respiratory infections are advantaged by multiple modes of transmission through direct or indirect contact (fomite), droplets and aerosols, and a large area of infectivity, 55–57 and both humoral and cellular immunity are required to clear infection and limit morbidity and mortality.”
BackgroundCOVID-19 Crisis Creates Opportunity towards Global Monitoring & Surveillance
Donia, A., Hassan, S.-U., Zhang, X., Al-Madboly, L. A., & Bokhari, H. (2021) · Pathogens · doi:10.3390/pathogens10030256 · Cited by 24
“In contrast, two relatively recent epidemic strains, severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and Middle East respiratory syndrome coronavirus (MERS-CoV) caused severe respiratory disease or pneumonia [7–11].”
BackgroundInfluentialTackling the COVID-19 Pandemic
Rahimi, F., & Abadi, A. T. B. (2020) · Archives of Medical Research · doi:10.1016/j.arcmed.2020.04.012 · Cited by 24
“Although the biochemical interaction of the receptor-binding domain of the surface-spike glycoprotein of SARS-CoV-2 with angiotensin-converting enzyme 2 in complex with the amino acid transporter BAT1 (SLC6A19) has recently been resolved by cryo-EM (6), many epidemiological aspects of the virus are yet to be explored…”
Sawakami, T., Karako, K., Song, P., Sugiura, W., & Kokudo, N. (2021) · BioScience Trends · doi:10.5582/bst.2021.01269 · Cited by 24
Bays, D. J., Nguyen, M.-V. H., Cohen, S. H., Waldman, S., Martin, C. S., Thompson, G. R., Sandrock, C., Tourtellotte, J., Pugashetti, J. V., Phan, C. T., et al. (2020) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2020.321 · Cited by 24
Tran, D. M., Tran, T. T., Phung, T. T. B., Bui, H. T., Nguyen, P. T. T., Vu, T. T., Ngo, N. T. P., Nguyen, M. T., Nguyen, A. H., & Nguyen, A. T. V. (2022) · Scientific Reports · doi:10.1038/s41598-022-16136-z · Cited by 25
Hemagglutinin stability as a key determinant of influenza A virus transmission via air
Tosheva, I. I., Saygan, K. S., Mijnhardt, S. M., Russell, C. J., Fraaij, P. L. A., & Herfst, S. (2023) · Current Opinion in Virology · doi:10.1016/j.coviro.2023.101335 · Cited by 23
Self-citationInfectious Respiratory Diseases Decreased during the COVID-19 Pandemic in South Korea
Kim, D. H., Nguyen, M., & Kim, J. H. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18116008 · Cited by 21
“Because respiratory infections may range from asymptomatic to life-threatening in the case of diseases such as pneumonia and sepsis [2], they are highly threatening to vulnerable populations such as children and the elderly due to their weaker immune systems [3,4].”
BackgroundEnvironmental SARS-CoV-2 contamination in hospital rooms of patients with acute COVID-19
Nagle, S., Tandjaoui-Lambiotte, Y., Boubaya, M., Gerber, A., Alloui, C., Bloch‐Queyrat, C., Carbonnelle, É., Brichler, S., Cohen, Y., Zahar, J., et al. (2022) · Journal of Hospital Infection · doi:10.1016/j.jhin.2022.05.003 · Cited by 22
“While direct droplet transmission, requiring close contact (<1 m), is recognized [1,2], debate continues in the literature regarding the risk of airborne in-hospital transmission and indirect transmission through contact with surfaces contaminated by biological secretions.”
Chen, Y., Wang, Y., Quan, N., Yang, J. J., & Wu, Y. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.874693 · Cited by 25
Zhan, J., Liu, Q. S., Sun, Z., Zhou, Q., Hu, L., Qu, G., Zhang, J., Zhao, B., & Jiang, G. (2020) · Environmental Pollution · doi:10.1016/j.envpol.2020.115621 · Cited by 22
Wang, H., Wei, W., Wang, K., Kong, H., Vieira, C. L. Z., Koutrakis, P., Huang, S., Xiong, J., & Giorio, C. (2025) · One Earth · doi:10.1016/j.oneear.2024.11.010 · Cited by 21
Do Slit-Lamp Shields and Face Masks Protect Ophthalmologists amidst COVID-19?
Ong, S. C., Razali, M. A. B., Shaffiee, L., Yap, J. X., Tay, T. Y. F., Loon, S. C., & Koh, V. (2020) · Ophthalmology · doi:10.1016/j.ophtha.2020.06.031 · Cited by 21
Recent updates on COVID-19: A holistic review
Jakhmola, S., Indari, O., Kashyap, D., Varshney, N., Rani, A., Sonkar, C., Baral, B., Chatterjee, S., Das, A., Kumar, R., et al. (2020) · Heliyon · doi:10.1016/j.heliyon.2020.e05706 · Cited by 20
“Infection feasibility [132] also gets transmitted through fomites in the close environment of an infected person [133, 134].”
Rhinovirus prevalence as indicator for efficacy of measures against SARS-CoV-2
Kitanovski, S., Horemheb-Rubio, G., Adams, O., Gärtner, B. C., Lengauer, T., Hoffmann, D. E., Kaiser, R., & Respiratory Virus Network (2021) · BMC Public Health · doi:10.1186/s12889-021-11178-w · Cited by 20
“HRSV, HAdV and EV are transmitted similarly to RV and SARS-CoV-2, namely via respiratory droplets and aerosols, and direct or indirect contact [21, 28, 29], while limited experimental data for HPIV3 hints at fomites as its main route of transmission [21].”
BackgroundNanostructures for the Prevention, Diagnosis, and Treatment of SARS-CoV-2: A Review
Kiremitler, N. B., Kemerli, M. Z., Kayacı, N., Karagöz, S., Pekdemir, S., Sarp, G., Sanduvaç, S., Önses, M. S., & Yılmaz, E. (2022) · ACS Applied Nano Materials · doi:10.1021/acsanm.2c00181 · Cited by 21
Nanotechnology and COVID-19: Prevention, diagnosis, vaccine, and treatment strategies
Ayan, S., Aranci, K., Çiftçi, F., & Üstündağ, C. B. (2023) · Frontiers in Materials · doi:10.3389/fmats.2022.1059184 · Cited by 24
“Also, studies have shown that aerosols can travel more than six feet due to their ability to be suspended in the air (Kutter et al., 2018).”
BackgroundAshokkumar, S., Kaushik, N. K., Han, I., Uhm, H. S., Park, J. S., Cho, G. S., Oh, Y., Shin, Y. O., & Choi, E. H. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms241814106 · Cited by 21
“Coronavirus diffusion occurs through direct contact between individuals, indirect contact via fomites, and airborne transmission through droplets and aerosols [12].”
BackgroundGonzález, N., Marquès, M., & Domingo, J. L. (2021) · Environmental Research · doi:10.1016/j.envres.2021.110826 · Cited by 21
Kawamoto, K., Stanojcic, N., Li, J.-P. O., & Thomas, P. B. M. (2021) · Asia-Pacific Journal of Ophthalmology · doi:10.1097/apo.0000000000000384 · Cited by 20
“com/apjoo and their patients are at particularly high risk of transmitting COVID-19 due to their close proximity during slit lamp and other ocular examinations.(2) One of the biggest challenges for teleconsultations is physical examinations.”
BackgroundPierre‐Bez, A. C., Agostini, G., Smith, P. B., Hong, Q., Hancock, D. S., Davis, M., Marcelli‐Munk, G., & Mitchell, J. C. (2021) · International Journal of Dental Hygiene · doi:10.1111/idh.12548 · Cited by 21
“) from the patient's head at various locations and [2] 1.”
Background
Metadata
- Authors
- Kutter, J. S., Spronken, M. I., Fraaij, P. L., Fouchier, R. A., & Herfst, S.
- Affiliations
- Erasmus MC (NL)
- Corresponding author
- Herfst, Sander
- Venue
- Current Opinion in Virology
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 28
- Pages
- 142-151
- ISSN
- 1879-6257 (ISSN-L)
- PMC
- PMC7102683
- OpenAlex
- W2786432367
- Cited by
- 611
- References
- 136
- Citations by year
- 2026: 28 · 2025: 41 · 2024: 52 · 2023: 80 · 2022: 98 · 2021: 153 · 2020: 137 · 2019: 14 · 2018: 7
- FWCI
- 13.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Current Opinion in Virology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Funders
- Seventh Framework Programme (602525)
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (91715372)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Keywords
- respiratory viruses, human-to-human transmission, transmission routes, airborne transmission, droplet transmission, respiratory infections, outbreak investigation, infection control, knowledge gaps
- MeSH terms
- Aerosols, Disease Outbreaks, Humans, Influenza, Human, Measles virus, Influenza A virus, Respiratory Tract Infections, Retrospective Studies, Virus Diseases, Observational Studies as Topic
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