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A2626 - Picking Up a Bug by Picking Your Nose Hand to Nose Transmission of Streptococcus PneumoniaeIn Healthy Participants a Pilot Study
Author Block: V. Connor1, R. Robinson1, E. German2, C. Hales1, A. Hyder-Wright1, A. Hugh2, S. R. Zaidi1, C. Lowe1, H. Hill2, E. Nikolaou2, S. Pojar2, E. Mitsi2, J. Reiné2, C. Solórzano2, B. Carniel2, J. Rylance2, H. Burhan1, D. Ferreira2; 1Royal Liverpool University Hospital Trust, Liverpool, United Kingdom, 2Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
Rational: Streptococcus pneumoniae (pneumococcus) is a leading cause of morbidity and mortality worldwide, causing community acquired pneumonia (CAP), otitis media, bacterial meningitis and septicaemia. Respiratory illnesses are reduced by hand washing, but for pneumococcus, the importance of non-aerosolised modes of spread is unknown. Our objective was to investigate the modes of transmission of S.pneumoniae from the hands to nose that would be used to cause colonisation. Methods: This study examines “hand-to-nose” transmission using a modification of our established controlled human infection model. 63 healthy volunteers were administered pneumococcus (serotype 6B) onto their fingertip or back of their hand, during spring-summer 2017. Volunteers were then asked to either sniff the bacterial residue, or make direct contact with the nasal mucosal surface (pick/poke their nose) immediately or after the bacterial residue is visibly dry. All volunteers were screened for respiratory virus before pneumococcal experimental exposure. Colonisation was defined as pneumococcal culture at any time point between day 2 and 9 post exposure. Molecular methods to detect pneumococcus (lytA qPCR assays) were used to investigate if any volunteers had low densities of colonisation not detectable using classical microbiological methods. Results: Colonisation rates were highest in those participants who poked their nose with wet pneumococcus (‘wet poke group’ 4/10, 40%), and who sniffed the wet bacteria from the back of the hand (‘wet sniff group’ 3/10, 30%). Drying of the bacteria on the skin before “sniff” or “poke” was associated with low colonisation rates (1/10 and 0/10 respectively). The ‘wet sniff’ technique was further investigated to improve precision of rates, extending the group to 33 participants, of which 6 were positive (18%). Virus was not associated with increased odds of colonisation. No adenovirus, influenza A or B, coronavirus, respiratory syncytial virus/human metapneumovirus, rhinovirus, parainfluenza 1-4 were found in 22 viral throat swab samples analysed (11 colonised participants matched with 11 non-colonised controls). Conclusion: We have shown that hands can be vehicles for transmission of Streptococcus pneumoniae and that wet particles increased transmission. This reinforces the imperative for good hand hygiene especially by populations at risk of invasive pneumococcal disease or pneumonia such as young children, elderly and immunosuppressed people. Lack of association in this study between colonisation and viruses, which has previously been reported in healthy volunteers, may be explained by the time of year the study was conducted.