A Hierarchical Framework for Assessing Transmission Causality of Respiratory Viruses

Overview

Journal Viruses

Publisher MDPI

Specialty Microbiology

Date 2022 Jul 27

PMID 35893670

Authors

Tom Jefferson

Carl J Heneghan

Elizabeth Spencer

Jon Brassey

Annette Pluddemann

Igho Onakpoya

David Evans

John Conly

Affiliations

Soon will be listed here.

Abstract

Systematic reviews of 591 primary studies of the modes of transmission for SARS-CoV-2 show significant methodological shortcomings and heterogeneity in the design, conduct, testing, and reporting of SARS-CoV-2 transmission. While this is partly understandable at the outset of a pandemic, evidence rules of proof for assessing the transmission of this virus are needed for present and future pandemics of viral respiratory pathogens. We review the history of causality assessment related to microbial etiologies with a focus on respiratory viruses and suggest a hierarchy of evidence to integrate clinical, epidemiologic, molecular, and laboratory perspectives on transmission. The hierarchy, if applied to future studies, should narrow the uncertainty over the twin concepts of causality and transmission of human respiratory viruses. We attempt to address the translational gap between the current research evidence and the assessment of causality in the transmission of respiratory viruses with a focus on SARS-CoV-2. Experimentation, consistency, and independent replication of research alongside our proposed framework provide a chain of evidence that can reduce the uncertainty over the transmission of respiratory viruses and increase the level of confidence in specific modes of transmission, informing the measures that should be undertaken to prevent transmission.

Citing Articles

Oro-faecal transmission of SARS-CoV-2: A systematic review of studies employing viral culture from gastrointestinal and other potential oro-faecal sources and evidence for transmission to humans.

Gandini S, Conly J, Spencer E, Evans D, Rosca E, Brassey J Epidemiol Infect. 2024; 152:e138.

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Revisiting the personal protective equipment components of transmission-based precautions for the prevention of COVID-19 and other respiratory virus infections in healthcare.

Plachouras D, Kacelnik O, Rodriguez-Bano J, Birgand G, Borg M, Kristensen B Euro Surveill. 2023; 28(32).

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Viral cultures, cycle threshold values and viral load estimation for assessing SARS-CoV-2 infectiousness in haematopoietic stem cell and solid organ transplant patients: a systematic review.

Jefferson T, Spencer E, Conly J, Rosca E, Maltoni S, Brassey J J Hosp Infect. 2022; 132:62-72.

PMID: 36473552 PMC: 9721162. DOI: 10.1016/j.jhin.2022.11.018.

Transmission of SARS-CoV-2 Associated with Cruise Ship Travel: A Systematic Review.

Rosca E, Heneghan C, Spencer E, Brassey J, Pluddemann A, Onakpoya I Trop Med Infect Dis. 2022; 7(10).

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SARS-CoV-2: public health measures for managing the transition to endemicity.

Byrne P, Harding-Edgar L, Pollock A J R Soc Med. 2022; 115(5):165-168.

PMID: 35357251 PMC: 9066679. DOI: 10.1177/01410768221089023.

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