Prolonged close contact alone may be insufficient for influenza transmission in real-world conditions
Influenza transmission is commonly assumed to occur readily through close interpersonal contact, particularly in indoor settings with limited ventilation. However, the relative importance of proximity versus viral shedding intensity, coughing, and aerosol generation remains incompletely resolved.
Study (PMID: 40657316)
A controlled human challenge–transmission study evaluated whether prolonged, close-range exposure to individuals with confirmed influenza infection resulted in secondary transmission under real-world–relevant conditions.
- Healthy adult volunteers
- Influenza A virus challenge in donor participants
- Naturally infected donors paired with uninfected recipients
- Prolonged close contact (shared room, low ventilation)
- No masking or physical barriers
- Continuous monitoring of viral shedding, coughing frequency, and recipient infection status
Findings
- Despite extended close contact, no secondary influenza infections were observed among recipient participants.
- Donors exhibited low aerosol viral shedding and minimal coughing, despite confirmed infection.
- Viral RNA was infrequently detected in fine aerosols, suggesting limited airborne source strength.
- These results suggest that proximity alone is insufficient for efficient transmission in the absence of substantial aerosol generation.
Together, the findings suggest that influenza spread depends more strongly on viral emission dynamics (including coughing frequency and aerosol shedding) than on duration of close contact alone.
Limitations
The study involved a small number of donors and recipients and used healthy adults with mild infection phenotypes, which may not reflect transmission dynamics in children, older adults, or individuals with more severe illness. Results should not be generalized to all respiratory viruses or higher-shedding influenza cases.
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https://www.news.gov.hk/eng/20....25/12/20251210/20251
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https://vimeo.com/1000344715
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https://www.mskcc.org/news/acu....puncture-may-ease-br
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