Scientists are tracking how the flu moves through a college campus

COLLEGE PARK, Md. — Campus life typically challenges students with new opportunities for learning, discovery — and intimacy with germs. Lots of germs.

That makes dormitories and their residents an ideal natural experiment to trace the germs’ paths. “You pack a bunch of college kids into a very small environment … we’re not known as being the cleanliest of people,” says sophomore Parker Kleb at the University of Maryland in College Park. Kleb is a research assistant for an ongoing study tracking the spread of respiratory viruses through a student population. The study’s goal is to better understand how these viruses move around, in order to help keep illness at bay — all the more pressing, as the current flu season is on track to be among the worst recorded in the United States.
Called “C.A.T.C.H. the Virus,” which stands for Characterizing and Tracking College Health, the study traces the trajectory of viral infections using blood samples, nasal swabs and breath samples from ailing freshmen and their closest contacts. (Tagline: It’s snot your average research study.)

Donald Milton, an environmental and occupational health physician-scientist, heads the project. On a recent day, he described the study to a classroom of freshmen he hopes to recruit. He ticked off questions this research seeks to answer: What is it that makes people susceptible to getting sick? What makes them contagious? And how do they transmit a virus to others? “Maybe your house, your room has something to do with whether you’re at risk of getting infected,” Milton said.

He had a receptive audience: members of the College Park Scholars’ Global Public Health program. Infection control is right up their alley. “How sick do we have to be?” one student asked. It’s the culprit that matters, she’s told. The study covers acute respiratory infections due to influenza viruses, adenoviruses, coronaviruses or respiratory syncytial virus, known as RSV.

Of most interest, however, is influenza. “Flu is important to everybody,” says Milton. Influenza is thought to spread among humans three ways — touch; coughing and sneezing, which launches droplets containing virus from the lungs onto surfaces; and aerosols, smaller droplets suspended in the air that could be inhaled (SN: 6/29/13, p. 9).
How much each of these modes of transmission contributes to the spread of viruses is a point of fierce debate, Milton says. And that makes infection control difficult, especially in hospitals. “If we don’t understand how [viruses] are transmitted, it’s hard to come up with policies that are really going to work.”
Milton and his colleagues recently reported that people with the flu can shed infectious virus particles just by breathing. Of 134 fine-aerosol samples taken when patients were breathing normally, 52 contained infectious influenza virus — or 39 percent, according to the study, published online January 18 in the Proceedings of the National Academy of Sciences . Those fine-aerosol particles of respiratory tract fluid are 5 microns in diameter or less, small enough to stay suspended in the air and potentially contribute to airborne transmission of the flu, the researchers say.
“This could mean that just having good cough and sneeze etiquette — sneezing or coughing into tissues — may not be enough to limit the spread of influenza,” says virologist Andrew Pekosz at Johns Hopkins University, who was not involved with the study. “Just sitting in your office and breathing could fill the air with infectious influenza.”

The C.A.T.C.H. study aims to find out if what’s in the air is catching. In two University of Maryland dorms, carbon dioxide sensors measure how much of the air comes from people’s exhalations. In addition, laboratory tests measure how much virus sick students are shedding into the air. To get those samples, students sit in a ticket booth‒sized contraption called the Gesundheit-II and breathe into a giant cone. These data can help researchers estimate students’ airborne exposure to viruses, Milton says.

Another key dataset comes from DNA testing of the viruses infecting the students. “The virus mutates reasonably fast,” Milton says, so the more people it’s moved through, the more changes it will have. By combining this molecular chain of transmission with the social chain of transmission, the researchers will try to “establish who infected whom, and where, and how,” Milton says.

The goal is to enroll 130 students in C.A.T.C.H. It’s doubtful they’ll all get sick, but not that many students from this initial group are needed to start the ball rolling, says Jennifer German, a virologist and C.A.T.C.H. student engagement coordinator. “For every index case that has an infection we’re interested in, we’re following four additional contacts,” she says. “And then if any of those contacts becomes sick, we’ll get their contacts and so on.”

The study began in November 2017. As of the end of January, German says, researchers have collected samples from five sick students, but only one was infected with a target virus, influenza. The researchers now are following three contacts from that case.

But timing and the size of the current flu outbreak may be on the researchers’ side. Kleb, the research assistant, says that students are still waiting for this season’s flu to sweep through the dorms. “Once one person gets sick, it goes around to everyone on the floor,” he says. “I’m very interested to see what happens in the next few weeks, and how the study will hopefully benefit.”