Banholzer, Nicolas; Jent, Philipp; Bittel, Pascal; Zürcher, Kathrin; Furrer, Lavinia; Bertschinger, Simon; Weingartner, Ernest; Ramette, Alban; Egger, Matthias; Hascher, Tina; Fenner, Lukas (30 December 2023). Air cleaners and respiratory infections in schools: A modeling study using epidemiological, environmental, and molecular data. medRxiv 10.1101/2023.12.29.23300635
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2023.12.29.23300635v1.full.pdf - Submitted Version Available under License Creative Commons: Attribution (CC-BY). Download (173kB) | Preview |
BACKGROUND
Using a multiple-measurement approach, we examined the real-world effectiveness of portable HEPA-air filtration devices (air cleaners) in a school setting.
METHODS
We collected environmental (CO2, particle concentrations), epidemiological (absences related to respiratory infections), audio (coughing), and molecular data (bioaerosol and saliva samples) over seven weeks during winter 2022/2023 in two Swiss secondary school classes. Using a cross-over study design, we compared particle concentrations, coughing, and the risk of infection with vs without air cleaners.
RESULTS
All 38 students (age 13-15 years) participated. With air cleaners, mean particle concentration decreased by 77% (95% credible interval 63%-86%). There were no differences in CO2 levels. Absences related to respiratory infections were 22 without vs 13 with air cleaners. Bayesian modeling suggested a reduced risk of infection, with a posterior probability of 91% and a relative risk of 0.73 (95% credible interval 0.44-1.18). Coughing also tended to be less frequent (posterior probability 93%). Molecular analysis detected mainly non-SARS-CoV-2 viruses in saliva (50/448 positive), but not in bioaerosols (2/105 positive) or HEPA-filters (4/160). The detection rate was similar with vs without air cleaners. Spatiotemporal analysis of positive saliva samples identified several likely transmissions.
CONCLUSIONS
Air cleaners improved air quality, showed a potential benefit in reducing respiratory infections, and were associated with less coughing. Airborne detection of non-SARS-CoV-2 viruses was rare, suggesting that these viruses may be more difficult to detect in the air. Future studies should examine the importance of close contact and long-range transmission, and the cost-effectiveness of using air cleaners.
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