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The Use of Povidone Iodine Nasal Spray and Mouthwash During the Current COVID-19 Pandemic May Protect Healthcare Workers and Reduce Cross Infection.

May 04, 2020 Draft version, awaiting journal acceptance and full peer review
The use of Povidone Iodine nasal spray and mouthwash during the current COVID-19
pandemic may reduce cross infection and protect healthcare workers.
Consultant Intensivist & Anaesthetist, Royal Surrey County Hospital
Consultant Advisor (ARMY) in OMFS, Defence Medical Services
VS Sunkaraneni LLM FRCS (2009)
Consultant Rhinologist, Royal Surrey County Hospital
SJ Challacombe, PhD, FRCPath, FDSRCS, FMedSci, DSc(h.c), FKC
Martin Rushton Professor of Oral Medicine, King’s College London
In late 2019 a novel coronavirus, SARS-CoV-2 causing Coronavirus disease 2019 (COVID-19)
appeared in Wuhan China, and on 11th March 2020 the World Health Organisation declared it to have
developed pandemic status. In early SARS-CoV-2 infection, viral titres of greater than 107/mL in
saliva and nasal mucous can be found; minimisation of these titres should help to reduce cross
infection. Povidone-iodine (PVP-I) disinfectant has better anti-viral activity than other antiseptics
and has already been proven to be an extremely effective virucide in vitro against severe acute
respiratory syndrome and Middle East respiratory syndrome coronaviruses (SARS-CoV and MERS-
CoV). Its in vivo virucidal activity is unknown, but it retains its antimicrobial activity against bacteria
in vivo intraorally and one application can reduce oral microbial flora for greater than 3 hours.
PVP-I disinfectant has been shown to be safe when administered to the nasal cavity and as a
mouthwash. We propose a protocolised intra-nasal and oral application of PVP-I for both patients
and their attendant healthcare workers (HCWs) during the current COVID-19 pandemic to help limit
the spread of SARS-CoV-2 from patients to healthcare workers and vice versa. The aim is to reduce
the viral ‘load’ in two of the key areas from where droplets and aerosols containing the virus are
expectorated (the lower respiratory tract being the other). The aim of use in HCWs is to destroy virus
that has entered the upper aerodigestive tract before it has the opportunity to infect the host.
We suggest the protocol is considered for routine use during the care of COVID-19 patients,
particularly before any procedure that involves the upper aerodigestive tract, including intubation,
nasal and oral procedures, endoscopy and bronchoscopy. We suggest it should be considered when
such procedures are carried out in all patients during the pandemic regardless of COVID-19 status,
due to the reported significant rates of asymptomatic infection
The total iodine exposure proposed is well within previously recorded safe limits in those without
contraindications to its use. The intervention is inexpensive, low risk and potentially easy to deploy
at scale globally.
Draft version, awaiting journal acceptance and full peer review
May 04, 2020 Draft version, awaiting journal acceptance and full peer review
The current COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, represents a
significant risk to healthcare workers with infection in this group representing nearly 4% of cases
early in the Chinese epidemic[1]. This may place an extra burden on healthcare environments at a
crucial time due to staff absence and spread to family members. Additionally, there is a significant
risk to non-infected patients already hospitalised and Wang et al reported in one centre that 41% of
their patients had suspected nosocomial transmission[2]. Critical care, for example, represents a
high-risk environment for nosocomial transmission of SARS-CoV-2 with procedures such as non-
invasive ventilation, intubation and suction causing a bioaerosol that may represent more of a
potential inoculum than by community transmission[3].
Saliva contains a high viral load in COVID-19 with up to 1·2×108 infective copies/mL when the
saliva of patients was analysed at the time of admission to hospital[4]. It has recently been found,
through PCR assay techniques, that the nasopharynx appears to have a higher viral load than that
found in the oropharynx[5]. As such, we feel that reduction of nasal viral titres is of at least as much
importance as in the oral cavity/oropharynx. Minimising, or at least reducing, viral titres in saliva
and nasal mucous expectorated by COVID-19 patients should be a key tenet in the battle to reduce
transmission of the disease. Doing so may well lessen the overall impact on the healthcare system by
reducing cross-infection from patients to healthcare workers and vice versa.
It is appreciated that virus in sputum from the lower respiratory tract is also of importance, but it is
not yet clear how viral titres vary between the upper and lower respiratory tracts. One small Korean
study[6] found that viral shedding was high during the early phase of illness, as did Zou[7], and was
higher in the upper compared with the lower respiratory tract, decreasing after day 7 of illness.
Povidone-iodine (iodine with the water-soluble polymer polyvinylpyrrolidone, PVP-I) was
discovered in 1955 at the Industrial Toxicology Laboratories in Philadelphia by H. A. Shelanski and
M. V. Shelanski. It was developed in order to find an antimicrobial iodine complex that was less
toxic than tincture of iodine, which caused burns. The antimicrobial action of PVP-I occurs after free
iodine (I2) dissociates from the polymer complex. Once in the free form, iodine rapidly penetrates
microbes and disrupts proteins and oxidises nucleic acid structures. This interaction ultimately results
in microbial death. PVP-I antibacterial activity is enhanced by dilution of the usually available 10%
w/w cutaneous solution, from 1:2 dilution up to a 1:100 dilution (0·1%), with a reduction in activity
occurring beyond 1:100.[8]
Virucidal activity
PVP-I has higher virucidal activity than other commonly used antiseptic agents including
chlorhexidine and benzalkonium chloride[9]. It has been shown to be active in vitro against the
coronaviruses that have caused epidemics in the last two decades, namely SARS-CoV causing the
severe acute respiratory syndrome (SARS) epidemic of 2002–3 and MERS-CoV the agent
responsible for causing the Middle East respiratory syndrome (MERS) epidemic of 2012–13.[10,11]
SARS-CoV-2 is highly homologous with SARS-CoV, and as such it is considered a close relative of
SARS-CoV[12]. Initial in vitro work looking at the virucidal activity of PVP-I against MERS-CoV
by Eggers’ group[13] showed that the lowest concentration of PVP-I to be effective was 1% when
used for 30 seconds under “dirty” conditions, leading to a reduction of viral activity of ≥99.99%;
however this was not effective at 0·1%[12]. In subsequent in vitro work by Eggers[14], the lowest
concentration tested and yet still effective against coronaviruses, was 0·23%. Kariwa showed that
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May 04, 2020 Draft version, awaiting journal acceptance and full peer review
treatment in vitro of SARS-CoV with various preparations of PVP-I for 2 minutes was enough to
reduce viral activity to undetectable levels[10]. The lowest concentration used was 0·23%, found in
an over the counter throat spray (Isodine Nodo Fresh®) available in Japan.
Safety and tolerance
Gargled PVP-I is very well tolerated when compared with other gargled antiseptic agents in common
use[15]. It has already been shown in clinically successfully trials using nasal administration and
mouthwash to reduce the incidence of nosocomial pneumonia by reducing pharyngeal bacterial
colonisation[16]. In Japan, iodine intake, largely from seaweeds, averages 1–3 mg per day without
significant associated negative health effects, other than the very low possibility of causing or
worsening symptoms for people with previously known thyroid autoimmunity or other underlying
thyroid issues[17]. A study looking at once daily use of 5% PVP-I mouthwash over a six-month
period showed no change in thyroid hormone levels (serum T3/T4 and free T4) with a small increase
in TSH levels, although all TSH levels remained in the normal range[18].
In a study looking at the excretion of iodine in healthy subjects, average ingestion of 88 mg per day
for a period of 38 days was undertaken without deleterious effects. They found that the majority of
iodine is cleared by the kidneys in urine, but an appreciable amount is excreted in sweat (35% of the
plasma concentration) and that faecal excretion is negligible[19]. The renal iodine clearance rate is
not influenced by the iodine intake; the process is neither adaptive nor saturable[20]. The World
Health Organisation recommended daily allowance of iodine for an adult is 0·15 mg[21]. PVP-I 10%
contains an equivalent of 11 mg/mL of iodine[22]. Our protocol would deliver less than 6 mg per day
for the duration of treatment of patients and less than 4 mg per day for staff, dependent on the
method of application as described in ‘Method of application’ below.
With decades of clinical use, the safety profile of PVP-I has been well established. Allergy to PVP-I
is extremely rare[23]; and in a clinical trial only 2 out of 500 patients showed positive contact
sensitivity to PVP-I (prevalence: 0·4%)[24] and although there have been occasional reports of type 1
allergy, these are considered exceptional[25]. There have been documented cases of significant
iodine toxicity with topical PVP-I use, one after prolonged sinus irrigation[26], the other with
prolonged wound application for 3–5 weeks[27], both using a 10% solution of PVP-I.
Clinical Usage
PVP-I is in ubiquitous use worldwide, both as a handwashing agent (usually a 7·5% solution
containing foaming agents) and for pre-procedural skin antisepsis (usually simply as a 10% solution).
The 10% is commonly used, and is licensed for, use on skin (multiple applications) and mucous
membranes (single application always review summary of product charateristics)It is used in
ophthalmic surgery (often diluted to 5%) and occasionally used in oral surgery at 10%.
PVP-I is commercially available in the Far East as a 1% w/v mouthwash for use every 2–4
hours[28] and as a 0·45% w/v ‘sore throat spray’ for use every 3–4 hours[29]. Chlorhexidine
mouthwash is used as the main antibacterial mouthwash in the UK, but chlorhexidine is not effective
against coronaviruses[9]. We do not know the exact effective concentration of PVP-I in the presence
of mucins and saliva, but we assume that using a concentration twice as strong as that found to be
virucidal in vitro (0·5% versus 0·23%[10,14]) will be effective, allowing for dilution due to saliva.
The topical application of iodine intranasally for the treatment of recalcitrant chronic rhinosinusitis
has been described by the St. Paul’s Sinus Centre team in Vancouver[30,31]. They used a 0·08%
solution, which they found to be beneficial for the management of this condition, but also did not
lead to any significant effect on thyroid function, mucociliary clearance or olfaction. PVP-I use in the
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May 04, 2020 Draft version, awaiting journal acceptance and full peer review
nasal cavity to reduce infection or spread is rational for COVID-19 after two recent trials have
demonstrated higher viral load there when compared with the oral cavity.[7,32]
Higher concentrations of 2·2% and 4·4% PVP-I in liposomal dispersions were trialled by Gluck et al
in a partially blinded, monocentric, prospective, controlled, randomised, single, 3-fold crossover
phase I study. Again, no change in mucosal appearance, olfactory function, ciliary activity or
subjective perception of nasal airflow were found[33]. Additionally, they were able to show that the
treatment was tolerable by subjects, and through comet assay that there was no genotoxicity. It is
difficult to be certain whether similar observations would be seen in a pure liquid preparation.
The clearance rate of mucin layers in the oral cavity in normal subjects is between 1 and 8 mm per
minute which equates to between 200 and 20 minutes in the oral cavity depending on the site and
flow rate[34]. Halides, including fluoride, bind to mucins and would have a similar clearance rate,
though the majority would be gone in under 10 minutes[35]. The flow rate of saliva in hospital
unconscious patients is very low, and clearance of PVP-I slower than normal.
Suggested Protocol
In the hospital setting, we propose that a 0·5% PVP-I solution (0·55 mg/mL available iodine) be
applied to the oral, oropharyngeal and nasopharyngeal mucosa of patients with presumed/confirmed
COVID-19 and the healthcare personnel in close contact with this cohort. At these concentrations
antiviral activity is still optimal and staining of teeth is minimal and reversible.
Additionally, we propose the same application of PVP-I for a second cohort, that includes all patients
having procedures (including examination) in or around the mouth and nose or procedures that
transit those areas and the healthcare professional carrying out those procedures. During the current
phase (April 2020 onwards) of the COVID-19 outbreak, the second cohort should include all
patients, not just those with suspected/confirmed COVID-19 infection. Procedures in the second
cohort would include, but not be limited to, dentistry and oral surgery, ENT examination and
treatment, endo-tracheal intubation, endoscopy and bronchoscopy.
Exclusion criteria: A history of allergy to PVP-I or its relevant excipients (alkyl phenol ether
sulphate (ammonium salt), disodium hydrogen phosphate dodecahydrate), all forms of thyroid
disease or current radioactive iodine treatment, lithium therapy, known pregnancy, renal failure and
dermatitis herpetiformis. The protocol should not be used in a sustained manner in children, but can
be used as a single episode, e.g. for dental treatment.
There is currently no commercially available iodine based ‘mouthwash’ in the UK. Instead, a 10%
solution of PVP-I licensed for oral mucosal use is diluted to 1:20 using sterile water to yield a 0·5%
w/v solution, which has 0·55 mg/mL available iodine. This is an ‘off-label’ use of a licensed product,
although a single application of diluted (or un-diluted) PVP-I to mucosa for antisepsis may be on
licence – check summary of product characteristics.
1. Patients must have exclusion criteria checked and to be informed of the benefits and risks of
the proposed treatment, with verbal consent taken and documented.
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2. Healthcare professions to be offered the administration as a form of PPE, with risks and
potential benefits explained and consent gained akin to prior to immunisation (e.g. the ‘flu
jab’), again after checking exclusion criteria
Method of application:
Step 1for all patients/ healthcare professionals in described groups: The 0·5% PVP-I solution
is administered in a dose of 0·28–0·3 ml into each nostril, preferably using an atomising device (2
sprays for an average device) or if not from a syringe. The contralateral nostril is occluded and the
recipient, if conscious, sniffs (with mouth closed) during the atomisation/instillation in order to
maximise coverage of the nasal cavity and nasopharynx. This will give a total dose of 0·33 mg of
Step 2 – conscious patients and healthcare professionals: 9 mL of the 0·5% PVP-I solution is then
introduced into the oral cavity and used as a mouthwash. Care is taken to ensure the solution is
distributed throughout the oral cavity for 30 seconds and then gently gargled or held at the back of
the throat for another 30 seconds before spitting out. It is assumed that at most 1 mL of the solution
will be retained (based on self-testing using high-accuracy scales, subtracting salivary production)
and absorbed, giving an anticipated maximum total dose of 0·55 mg of iodine. If a nasal pump
atomising device is used, 7 sprays are used aimed in different directions and then ‘licked’ around the
inside of the oral cavity, yielding 0·54 mg of iodine (0·14 mL per actuation for most commercially
available nasal atomisers at 0·077 mg iodine per actuation).
Step 2 – unconscious patients. At the time of routine mouthcare, an oral care sponge swab or similar
is soaked in 2 mL of 0·5% PVP-I solution and carefully wiped around all oral mucosal surfaces.
Most of this solution will be retained in the mouth/ oropharynx (a small amount remaining in the
sponge), giving a maximum total dose of 1·1 mg iodine.
Timing of delivery:
Patients hospitalised for confirmed/ suspected COVID 19 and healthcare workers engaged in
their care: Steps 1 & 2 should be undertaken every 6 hours for patients and up to four times per day
for healthcare workers (maximal frequency two hourly). For healthcare workers, it is advised that
steps 1 & 2 are performed prior to contact with the patient/patients and if repeated contact is
occurring, repeated every 2–3 hours, up to 4 times per day. This will give a maximum iodine intake
of 3·52 mg for HCW and conscious patients and 5·72 mg for unconscious patients.
Patients attending for dentistry/oral surgery, ENT examination and treatment, endoscopy and
bronchoscopy and any other action to be carried out close to or in the mouth or nose: The
patient should undergo steps 1 & 2 prior to examination or treatment. Healthcare workers conducting
the procedure or in close proximity should perform steps 1 & 2 prior to contact with the patient and if
multiple patients are being seen, repeat every 2–3 hours, up to 4 times a day. Dosages are the same as
above, but are single exposures for patients.
The evidence presented suggests that application of povidone iodine to the nasal and oral mucosae,
including the oro/nasopharynx, of patients with COVID-19 may significantly reduce the viral load in
those key anatomical areas. This may reduce the risk of transmission to HCW providing routine care
as well as allowing a period of time to perform procedures at reduced risk. Further reduction of risk
of transmission may be achieved by similar application of PVP-I to the HCW providing the care as a
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May 04, 2020 Draft version, awaiting journal acceptance and full peer review
form of prophylaxis. We therefore propose that for the duration of the current COVID-19 pandemic
urgent consideration should be given to the application of PVP-I to patients and HCWs as described
above. This includes patients with no symptoms of COVID-19 having procedures in or around the
mouth and nose or procedures that transit those areas and the healthcare professionals carrying out
those procedures due to the high incidence of asymptomatic infection.
We accept, however, that direct testing and demonstration of the virucidal activity of PVP against
SARS-CoV-2 has not been documented. However, the evidence in the literature shows that PVP-I is
rapidly virucidal in vitro and its use in the manner we propose was recommended by Eggers et al, for
reduction of coronavirus load in the oral cavity to help prevent MERS-CoV transmission, and this
has not been contested[13]. The proposed protocol is for disinfection of the oral and nasal cavities,
akin to the recommended practice of hand sanitisation for transmission reduction, but at the major
route of spread (potentially preventing infected patients from passing on the virus) and at a portal of
virus entry for HCW (potentially protecting them from being infected via the nose/mouth). It is
accepted that aerosolised secretions from the lower respiratory tract almost certainly have a part to
play in disease transmission and therefore that this proposal forms only part of the strategy to reduce
transmission, as an adjunct to other elements of personal protective equipment.
This intervention is not provided with curative intent for the disease, but may provide a major step to
dramatically reduce viral spread within the healthcare workplace. In low and middle-income
countries that are soon likely to suffer expansion of the pandemic, the number of healthcare workers
per capita is considerably lower, and conventional physical personal protective equipment will
probably be in very short supply. Every possible step should be taken to keep HCWs from being
infected and able to offer care to reduce mortality from COVID-19. The proposed intervention is
applicable to every HCW exposed to both proven or suspected cases to reduce their risk.
Additionally, use in clinical scenarios where there is prolonged close proximity of the upper
aerodigestive tracts of patients and HCWs combined with aerosol generating procedures, such as
general dental practice and ENT clinics, may reduce transmission, especially when treating patients
with asymptomatic COVID-19.
It has been assumed that PVP-I shows the same virucidal activity to SARS-CoV-2 in vitro as has
been shown with other coronaviruses, but the exact duration of virucidal action of PVP-I once
applied to the mucosae is currently unknown, as is the length of time for the viral load to recover to
pre-treatment levels, or if it does at all. However, in ventilated patients PVP-I solution has been
shown to significantly reduce bacterial flora for at least three hours[36]. The high levels of SARS-
CoV-2 in both the nose and oral cavity strongly suggest that productive replication is occurring in the
mucosae in both sites. Both nasal and oral tissues have been shown to express the ACE-2
receptor[38] and epithelial cells lining salivary duct cells may be early targets of infection by
coronaviruses[39] as well as nasal goblet and ciliated cells in the nose[40]. On the basis of these
studies and the clearance rate of mucins from both nose and mouth, we suggest that an expectation of
a 20-minute window of lowered viral loads is reasonable, although once present on the mucosa the
time taken for viral particles to infect host cells and replicate is also unknown. Research is currently
being undertaken to determine if PVP-I kills SAR-CoV-2 in the human oral and nasal cavities and, if
so, the duration of virucidal action on mucosae.
We consider that it is important to avoid aerosols from either nose or mouth since droplets of even a
few microlitres may contain many thousands of infectious virus particles. Thus, the application of the
nasal spray requires insertion into the anterior nares and a sniff with concurrent occlusion of the
contralateral nose and a closed mouth to avoid bioaerosols from the mouth or nose. The American
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Dental Association have recently published interim guidelines for minimising the risk of COVID-19
transmission which includes the use of a pre-operative 0·2% PVP-I mouthwash[41].
For the ventilated patient there is possible added value of the suggested PVP-I protocols. Adverse
effects of ventilation include rhinosinusitis and aspiration pneumonia. Nasal and oral bacterial
loads[37] are significantly reduced by PVP-I and PVP-I use is a recommended therapeutic
intervention for recalcitrant rhinosinusitis[30] and for prevention of aspiration pneumonia[36].
The total dose of iodine absorbed by the suggested regimen is not known exactly. If 100% of the
nasal spray used were to be absorbed and a similar amount absorbed from the mouthwash, then this
would amount to 5·72 mg of iodine per day. For staff, who would be potentially exposed to
prolonged use, this figure is 3·52 mg per day. This is far below experimental studies showing lack of
any toxicity after ingesting 88 mg daily for 28 days[19] and close to normal dietary intake in
Japan[17]. In Aders study[18], 6 months of use of daily 5% PVP-I mouthwashes, equivalent to
5·5mg per day if 1 mL is retained and absorbed as estimated in this paper, caused no change in serum
T3, T4 or free T4. While there was a small increase in TSH, in all subjects this remained within
normal range[18]. In addition, upon cessation, the extrapolation of excretion data from Nelson et
al[19], suggests complete urinary clearance by 5 days using their slowest clearance data, and our use
is far below their maxima, which yielded no ill effects. For perspective, taking 200 mg of
amiodarone once per day would be expected to release 7·5 mg of free iodide[42]. Hence we believe
that as long as the exclusion criteria are followed, there should be no deleterious effect to HCW or
patients due to increased iodine intake from this protocol.
Hence in deciding the dosing regimen for patients and healthcare workers we balance the risk of
iodine toxicity versus the protective effect of PVP-I. There are very few contraindications to using
PVP-I as a mouthwash or nasal spray. Its administration is cheap, simple and rapid using our
methods. PVP-I is readily available in healthcare worldwide. Sensitisation is extremely rare.
There is considerable evidence of benefit for the use of PVP-I antiseptic for the maintenance of oral
health prevention and treatment of oropharyngeal infections, but there is a noted discordance
between the evidence base and translation into clinical practice[37]. As an adjunct to currently
recommended PPE used during management of COVID-19 patients, we recommend the
consideration of immediate use of PVP-I in healthcare workers and their patients as described to
minimise the risk of spread of the disease. We acknowledge that the proposal we present extrapolates
in vitro finding into the in vivo setting and that assumptions are made that under normal
circumstances we would confirm with in vivo data prior to recommendations for use. However,
given the strength of in vitro evidence and the low risk, minimal cost and global applicability of the
proposed intervention, which amounts to disinfection of the oro/nasal cavities, we feel that there is
little to lose and potentially much to gain.
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... Isolation and social distancing [15,18] Washing the hands frequently using an alcohol-based hand sanitizer [3,5,24] Avoiding touching eyes, nose, and mouth when outside [5] Wearing face masks [3] Covering coughs and sneezes [5] Avoiding crowded places [5] Avoiding traveling [3,5,24] Avoiding public transportation [3,5,24] Opening windows for ventilation in shared areas such as toilets and kitchens and having well-ventilated single rooms [3] Using of povidone-iodine nasal spray and mouthwash to reduce cross infection and protect healthcare workers [25,26] Using a humidifier, as higher air humidity reduces virus survival for other viruses and may decrease transmission [3] Remaining updated and well-informed about the virus [5,27] Practicing good respiratory hygiene [28] Isolating vulnerable populations such as elderly people, pregnant women, and people with co-morbid conditions such as hypertension and diabetes mellitus [28] Women with infants are encouraged to breastfeed their babies to enhance their immunity [5] Stress-relieving measures are equally important to follow [28] Monitoring personal health daily [3,20] Since 2020, several clinical trials have been performed to find an efficient and safe treatment for COVID-19, but until now, no therapy has been approved for COVID-19 pneumonia. From the WM point of view, there are some therapeutic strategies that have been used from the beginning of the pandemic; these are summarized in Table 2. ...
... Oily decoctions and warm liquids can thoroughly clean the oral cavity, pharynx, and tonsillar area, forming a protective biofilm that may induce immunomodulatory, antioxidant, and antimicrobial effects on the mucosa. [8,26] Nasal oil application Applying medicated oils made from Ghee or vegetable oils such as sesame or coconut in the nostrils is believed to protect the respiratory tract against pathogen invasion. Two drops of sesame oil should be applied to each nostril every morning to prevent respiratory diseases and dry nasal mucosa. ...
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The rapid spread of the new coronavirus disease (COVID-19) caused by SARS-CoV-2 has become a global pandemic. Although specific vaccines are available and natural drugs are being researched, supportive care and specific treatments to alleviate symptoms and improve patient quality of life remain critical. Chinese medicine (CM) has been employed in China due to the similarities between the epidemiology, genomics, and pathogenesis of SARS-CoV-2 and SARS-CoV. Moreover, the integration of other traditional oriental medical systems into the broader framework of integrative medicine can offer a powerful approach to managing the disease. Additionally, it has been reported that integrated medicine has better effects and does not increase adverse drug reactions in the context of COVID-19. This article examines preventive measures, potential infection mechanisms, and immune responses in Western medicine (WM), as well as the pathophysiology based on principles of complementary medicine (CM). The convergence between WM and CM approaches, such as the importance of maintaining a strong immune system and promoting preventive care measures, is also addressed. Current treatment options, traditional therapies, and classical prescriptions based on empirical knowledge are also explored, with individual patient circumstances taken into account. An analysis of the potential benefits and challenges associated with the integration of complementary and Western medicine (WM) in the treatment of COVID-19 can provide valuable guidance, enrichment, and empowerment for future research endeavors.
... Short-term use of PVP-I has not been shown to irritate healthy or diseased oral mucosa or exhibit adverse effects, such as discoloration of teeth and tongue or change in taste [72]. PVP-I was found to be favorably tolerated by children receiving PVP-I for dental conditions, however, recommended not to be used in pediatric patients of below 6 years [14,72,73]. Some researchers and clinicians suggested that, in hospital settings in case of suspected or confirmed COVID-19 patients, 0·5% PVP-I solution (0·55 mg/mL available iodine) can be applied to the oral, oropharyngeal and nasopharyngeal mucosa of patients with the healthcare personnel in close contact to prevent cross infection [73]. ...
... PVP-I was found to be favorably tolerated by children receiving PVP-I for dental conditions, however, recommended not to be used in pediatric patients of below 6 years [14,72,73]. Some researchers and clinicians suggested that, in hospital settings in case of suspected or confirmed COVID-19 patients, 0·5% PVP-I solution (0·55 mg/mL available iodine) can be applied to the oral, oropharyngeal and nasopharyngeal mucosa of patients with the healthcare personnel in close contact to prevent cross infection [73]. 0.2% povidone-iodine may reduce the risk of ventilator pneumonia [67,74,75]. ...
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The novel coronavirus disease, first identified in 2019 known as COVID-19, is caused by a new strain of severe acute respiratory syndrome coronavirus (SARS-CoV or SARS-CoV-1), named as SARS-CoV-2. Recent studies showed that the virus may be airborne and spreads through small respiratory droplets of saliva in aerosols, indirect or direct physical contact of the affected individual, in a similar way to the cold and influenza. Emerging studies also demonstrate the importance of throat along with salivary glands as sites of viral replication and transmission in early COVID-19 infection. The most common route of entry of SARS-CoV-2 is the upper respiratory tract (nasopharynx) that slowly reaches to the lower respiratory tract to infect the epithelial cells within the lungs which can cause lung damage and severe respiratory symptoms, if not treated immediately. Averting colonization of the virus in the nasopharynx could be one of the best options to reduce the incidence of severe infection. It has been well documented that iodine is one of the most effective of all antimicrobials available. Hospitals and medical facilities worldwide use povidone-iodine (PVP-I) as a standard of care in infection control. Several research studies during the ongoing COVID-19 pandemic showed the in-vitro and in-vivo efficacy of iodine containing solutions like PVP-I (Betadine), Iodine-V (Essential Iodine Drops) etc. and other iodine complexes to effectively kill the SARS-CoV-2 virus within few seconds to hours. Few commercially available iodine containing gargling, mouthwash and nasal spray solutions has been recommended to use in humans against SARS-CoV-2 infection by the experts to prevent viral spread especially among health workers. The present article aims to summarize these studies and highlights the rationale, safety and recommendations of use of molecular iodine as an effective method to decrease the viral load during the early COVID-19 infection.
... Povidone iodine has been demonstrated to have high virucidal action for up to three hours, and it has lately been recommended to cover the patient's mouth cavity and nasal passages, as well as the operating team's, prior to the procedure. [19] Extraoral techniques such as OPG and cone beam CT should be [20][21] containing hand rub. ...
... In the present study, the most used mouthwash was povidone-iodine (PVP-I) (Fig. 3B). Research has yet to show a clinically effective reduction in the salivary load of SARS-CoV2 at a large population scale associated with gargling with mouthwashes, although gargling with chlorhexidine [34], 1-1.5% hydrogen peroxide [35], cetylpiridinium chloride (CPC) [36], or PVP-I [37] mouthwashes in advance of dental procedures has been reported to reduce viral loads in vitro, which in turn may inhibit COVID-19 transmission during dental procedures [38,39]. At present, the recommended antimicrobial mouthwashes are chlorhexidine gluconate, cetylpyridinium chloride, PVP-I, and hydrogen peroxide [38]. ...
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Abstract Background Dental practitioners have a high risk of contracting COVID-19 during the treatment of patients because of exposure to airborne droplets. However, the application of pre-procedure treatment screening in dental practices in Indonesia varied during the pandemic. The purpose of this study was to investigate the use of updated pre-procedure dental treatment protocols and procedures among dental practitioners in Indonesia. Methods This study consisted of dentists registered as members of the Indonesian Dental Association who attended the Indonesian Dental Association webinar series in 2021. All the participants completed a questionnaire survey. The participants, who were from various regions in Indonesia, were granted password-protected access to a URL hosting the questionnaire. The questionnaire collected demographic information and contained questions on adherence to updated protocols and patient screening procedures, to which the respondents answered “Yes” or “No”. For the analysis, the participants were divided into three groups based on the type of facility where they were employed: public (government) hospitals, private hospitals, or university hospitals (dental schools). A chi-square test was used to investigate the association between professional background and the implementation of updated protocols, including pre-procedure dental treatment screening. A value of P
... Povidone-iodine may inactivate COVID-19, thus reducing its infectivity 25 , and a protocol based on povidone-iodine nasal spray and mouthwash has already been proposed during the actual epidemic to reduce cross infection and protect healthcare workers. 26 After that, another mouth rinse with 0.2/0.3% chlorhexidine for 1 min was performed to reduce the bacterial load in the aerosol. ...
Full-text available
Soon after the advent of this pandemic the whole world got affected by this disease and particularly the dentists suffered both academically and clinically as clinical procedures of dentistry generate aerosols which can cause infection in the dental environment and for the dentists too. Many protocols were followed that helped in the reduction of spread of this contagious virus. At all levels prevention of covid-19 was done and during the lockdown phase, dentists treated only emergency cases which increased the dental demand and because dentists were at higher risk for having infection, thus many new strategies of having a triage and practicing tele-dentistry came into existence. Though in the current time covid is not much prevalent but all the protocols of practicing a safe dentistry should be continued as it will prevent the covid to spread even in a minimal amount. Dentistry has always been of use to a major amount of population hence it is very important for the dentists to practice dentistry safely both during the times of outbreak of a disease and also during normal times.
... The fast series of samples and trying out of suspect instances the use of molecular diagnostic tests (NAAT) which include RT-PCR is an essential detail in frequency of intense events. [44] A supplemental studies technique Serological or antibody trying out is a serum survey of instances with poor NAAT assays however a sturdy epidemiological hyperlink to COVID-19 with inside the case of an ongoing pandemic. In those instances, paired serum samples can be used to help the prognosis as soon as legitimate and dependable serology databases had been recommended. ...
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The progressive coronavirus pandemic (COVID-19) has prompted extreme harm to healthcare companies everywhere in the world, consisting of dental experts in practices, universities, and studies centers. The intention of this observes changed into to evaluate the literature on key components of dentistry in terms of COVID-19, in addition to speak about the epidemic's capacity outcomes on implant practice, teeth healthcare, and facts analysis. Despite the fact that the coronavirus epidemic has created numerous challenges for clinical dentistry, dental educators can modernize their teaching methods by incorporating fresh digital concepts in clinical skill teaching as well as improving digital media and educational platforms. This pandemic has additionally highlighted a number of the maximum extensive gaps in dental research, in addition to the want for new, manner of expertise to control the presentday disaster and mitigate the effect of destiny disorder outbreaks on dentistry. Finally, COVID-19 has ended in a slew of pressing oral problems, a number of that may have prolonged implications for patient, dental education, and studies.
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Introduction: The novel Coronavirus Disease-2019 (COVID-19) spreads through respiratory droplets, and various strategies have been developed to reduce its spread. One of these strategies is the use of oral rinses, such as chlorhexidine, povidone iodine, and hydrogen peroxide (H2 O2 ), to reduce the viral load. However, while these rinses have advantages in preventing the spread of the virus, they may also have adverse effects on restorative materials in the oral cavity, particularly dental ceramics. The usage of mouthwashes during the pandemic may affect the surface roughness of dental ceramics, leading to plaque accumulation. Aim: The aim of this study was to evaluate the surface roughness of ceramics after immersion in different oral rinses for seven, 15, and 30 days. Materials and Methods: An in vitro study was conducted in the Department of Prosthodontics at Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India. The study was conducted over a period of four months, from October 2021 to January 2022. A total of 51 specimens of dental ceramics were fabricated using a mold with dimensions of 10 mm diameter x 2 mm height. These specimens were randomly divided into three groups based on the immersion solution: distilled water, hydrogen peroxide, and povidone iodine. Each immersion cycle lasted for one minute, and the immersion was performed for 30 days. Surface analysis was carried out using a Surftester at intervals of seven, 15, and 30 days. The data were statistically analysed using the Statistical Package for Social Sciences (SPSS) version 26.0. Intergroup comparison (>2 groups) was performed using the Kruskall-Wallis test, and Analysis of Variance (ANOVA) followed by pairwise comparison using the Mann-Whitney U test. A p-value of
Background and aim: This study evaluates the salivary viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in hospitalized patients and outpatients before and after gargling with 1% hydrogen peroxide and 0.25% povidone-iodine in comparison with normal saline. Patients and methods: This clinical trial was conducted on 120 participants with laboratory-confirmed coronavirus disease 2019 (COVID-19) in two groups: outpatients (n = 60) and hospitalized patients (n = 60). In each group, the patients were randomly divided into three subgroups of 20 based on their given mouthwash for gargling (hydrogen peroxide, povidone-iodine, or normal saline). Two saliva samples were taken from each patient: the first one before gargling and the second one 10 minutes after gargling 10 ml of the respected mouthwashes for 30 seconds. The TaqMan real-time polymerase chain reaction (PCR) amplification of SARS-CoV-2 was used to measure the viral load. Results: Saliva samples from 46% of patients were positive for coronavirus before gargling the mouthwashes. The percentage of patients with an initial positive saliva sample was significantly higher in the outpatient group (83.3%) than in the hospitalized group (5.4%) (P = 0.01). According to the findings, gargling any mouthwash similar to saline did not reduce the viral load (P > 0.05). Conclusion: The saliva of COVID-19 patients in the initial stage of the disease was more likely to contain SARS-CoV-2 than the saliva of the hospitalized patients. Gargling hydrogen peroxide or povidone-iodine did not reduce the salivary SARS-CoV-2 viral load.
Full-text available
Soon after the advent of this pandemic the whole world got affected by this disease and particularly the dentists suffered both academically and clinically as clinical procedures of dentistry generate aerosols which can cause infection in the dental environment and for the dentists too. Many protocols were followed that helped in the reduction of spread of this contagious virus. At all levels prevention of covid-19 was done and during the lockdown phase, dentists treated only emergency cases which increased the dental demand and because dentists were at higher risk for having infection, thus many new strategies of having a triage and practicing tele-dentistry came into existence. Though in the current time covid is not much prevalent but all the protocols of practicing a safe dentistry should be continued as it will prevent the covid to spread even in a minimal amount. Dentistry has always been of use to a major amount of population hence it is very important for the dentists to practice dentistry safely both during the times of outbreak of a disease and also during normal times.
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A pandemia pelo novo Coronavírus (Covid-19) tem sido um grande desafio. Se tornou evidente a necessidade da presença do Cirurgião Dentista (CD) nos hospitais. Neste cenário, o estudo objetivou avaliar os protocolos de cuidados bucais durante a pandemia pelo Covid-19 nas Unidades de Terapia Intensiva (UTIs) de um hospital do município de Belo Horizonte, Minas Gerais, sob o olhar dos profissionais da linha de frente. Trata-se de um estudo observacional descritivo envolvendo a aplicação de um questionário aos profissionais CDs e os demais que compõem a equipe multidisciplinar que atuam nas UTIs do hospital no período de outubro de 2021 a março de 2022. Os resultados mostraram um total de 153 profissionais que responderam à pesquisa sendo 70% do sexo feminino. Mais de 2/3 dos profissionais receberam treinamento para avaliação de condições de saúde bucal em pacientes hospitalizados. O protocolo de higiene oral utilizado foi remoção mecânica do biofilme associado ao uso de digluconato de clorexidina 0,12%. As condições de saúde bucais mais prevalentes observadas foram a halitose e trauma nos lábios por uso prolongado do tubo de ventilação mecânica. Dessa forma, observou-se que a maioria dos profissionais se sentiu preparado para o atendimento de pacientes com diagnóstico confirmado de Covid-19. Mesmo durante a pandemia o serviço se manteve atento aos protocolos de cuidado e biossegurança, houve mudança de protocolo de higiene bucal e a equipe aderiu às novas abordagens dos pacientes graves acometidos pelo novo coronavírus. Além disso, concluiu-se que o CD intensivista é extremamente importante na equipe multiprofissional.
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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pneumonia emerged in Wuhan, China in December 2019. In this retrospective multicenter study, we investigated the clinical course and outcomes of novel coronavirus disease 2019 (COVID-19) from early cases in Republic of Korea. Methods: All of the cases confirmed by real time polymerase chain reaction were enrolled from the 1st to the 28th patient nationwide. Clinical data were collected and analyzed for changes in clinical severity including laboratory, radiological, and virologic dynamics during the progression of illness. Results: The median age was 40 years (range, 20-73 years) and 15 (53.6%) patients were male. The most common symptoms were cough (28.6%) and sore throat (28.6%), followed by fever (25.0%). Diarrhea was not common (10.7%). Two patients had no symptoms. Initial chest X-ray (CXR) showed infiltration in 46.4% of the patients, but computed tomography scan confirmed pneumonia in 88.9% (16/18) of the patients. Six patients (21.4%) required supplemental oxygen therapy, but no one needed mechanical ventilation. Lymphopenia was more common in severe cases. Higher level of C-reactive protein and worsening of chest radiographic score was observed during the 5-7 day period after symptom onset. Viral shedding was high from day 1 of illness, especially from the upper respiratory tract (URT). Conclusion: The prodromal symptoms of COVID-19 were mild and most patients did not have limitations of daily activity. Viral shedding from URT was high from the prodromal phase. Radiological pneumonia was common from the early days of illness, but it was frequently not evident in simple CXR. These findings could be plausible explanations for the easy and rapid spread of SARS-CoV-2 in the community.
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SARS-CoV-2 has caused tens of thousands of infections and more than one thousand deaths. There are currently no registered therapies for treating coronavirus infections. Because of time consuming process of new drug development, drug repositioning may be the only solution to the epidemic of sudden infectious diseases. We systematically analyzed all the proteins encoded by SARS-CoV-2 genes, compared them with proteins from other coronaviruses, predicted their structures, and built 19 structures that could be done by homology modeling. By performing target-based virtual ligand screening, a total of 21 targets (including two human targets) were screened against compound libraries including ZINC drug database and our own database of natural products. Structure and screening results of important targets such as 3-chymotrypsin-like protease (3CLpro), Spike, RNA-dependent RNA polymerase (RdRp), and papain like protease (PLpro) were discussed in detail. In addition, a database of 78 commonly used anti-viral drugs including those currently on the market and undergoing clinical trials for SARS-CoV-2 was constructed. Possible targets of these compounds and potential drugs acting on a certain target were predicted. This study will provide new lead compounds and targets for further in vitro and in vivo studies of SARS-CoV-2, new insights for those drugs currently ongoing clinical studies, and also possible new strategies for drug repositioning to treat SARS-CoV-2 infections.
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Importance In December 2019, novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited. Objective To describe the epidemiological and clinical characteristics of NCIP. Design, Setting, and Participants Retrospective, single-center case series of the 138 consecutive hospitalized patients with confirmed NCIP at Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1 to January 28, 2020; final date of follow-up was February 3, 2020. Exposures Documented NCIP. Main Outcomes and Measures Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared. Presumed hospital-related transmission was suspected if a cluster of health professionals or hospitalized patients in the same wards became infected and a possible source of infection could be tracked. Results Of 138 hospitalized patients with NCIP, the median age was 56 years (interquartile range, 42-68; range, 22-92 years) and 75 (54.3%) were men. Hospital-associated transmission was suspected as the presumed mechanism of infection for affected health professionals (40 [29%]) and hospitalized patients (17 [12.3%]). Common symptoms included fever (136 [98.6%]), fatigue (96 [69.6%]), and dry cough (82 [59.4%]). Lymphopenia (lymphocyte count, 0.8 × 10⁹/L [interquartile range {IQR}, 0.6-1.1]) occurred in 97 patients (70.3%), prolonged prothrombin time (13.0 seconds [IQR, 12.3-13.7]) in 80 patients (58%), and elevated lactate dehydrogenase (261 U/L [IQR, 182-403]) in 55 patients (39.9%). Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy (62 [44.9%]). Thirty-six patients (26.1%) were transferred to the intensive care unit (ICU) because of complications, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%]). The median time from first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to ARDS was 8.0 days. Patients treated in the ICU (n = 36), compared with patients not treated in the ICU (n = 102), were older (median age, 66 years vs 51 years), were more likely to have underlying comorbidities (26 [72.2%] vs 38 [37.3%]), and were more likely to have dyspnea (23 [63.9%] vs 20 [19.6%]), and anorexia (24 [66.7%] vs 31 [30.4%]). Of the 36 cases in the ICU, 4 (11.1%) received high-flow oxygen therapy, 15 (41.7%) received noninvasive ventilation, and 17 (47.2%) received invasive ventilation (4 were switched to extracorporeal membrane oxygenation). As of February 3, 47 patients (34.1%) were discharged and 6 died (overall mortality, 4.3%), but the remaining patients are still hospitalized. Among those discharged alive (n = 47), the median hospital stay was 10 days (IQR, 7.0-14.0). Conclusions and Relevance In this single-center case series of 138 hospitalized patients with confirmed NCIP in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.
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With reports of vancomycin-resistant enterococci recently emerging in hospital settings, renewed focus is turning to the importance of multifaceted infection prevention efforts. Careful compliance with established hygiene practices by healthcare workers together with effective antiseptic options is essential for the protection of patients from infectious agents. For over 60 years, povidone iodine (PVP-I) formulations have been shown to limit the impact and spread of infectious diseases with potent antiviral, antibacterial and antifungal effects. In addition to a lack of reported resistance, the benefits of PVP-I include an excellent safety profile and a broad spectrum of effect due to its multimodal action. Studies have shown that hand washing with PVP-I-based antiseptics is effective for the decontamination of skin, while PVP-I mouthwashes and gargles significantly reduce viral load in the oral cavity and the oropharynx. The importance of PVP-I has been emphasised by its inclusion in the World Health Organization’s list of essential medicines, and high potency for virucidal activity has been observed against viruses of significant global concern, including hepatitis A and influenza, as well as the Middle-East Respiratory Syndrome and Sudden Acute Respiratory Syndrome coronaviruses. Together with its diverse applications in antimicrobial control, broad accessibility across the globe, and outstanding safety and tolerability profile, PVP-I offers an affordable, potent, and widely available antiseptic option.
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Introduction: Recent virus epidemics and rising antibiotic resistance highlight the importance of hygiene measures to prevent and control outbreaks. We investigated the in vitro bactericidal and virucidal efficacy of povidone-iodine (PVP-I) 7% gargle/mouthwash at defined dilution against oral and respiratory tract pathogens. Methods: PVP-I was tested against Klebsiella pneumoniae and Streptococcus pneumoniae according to bactericidal quantitative suspension test EN13727 and against severe acute respiratory syndrome and Middle East respiratory syndrome coronaviruses (SARS-CoV and MERS-CoV), rotavirus strain Wa and influenza virus A subtype H1N1 according to virucidal quantitative suspension test EN14476. PVP-I 7% gargle/mouthwash was diluted 1:30 with water to a concentration of 0.23% (the recommended concentration for "real-life" use in Japan) and tested at room temperature under clean conditions [0.3 g/l bovine serum albumin (BSA), viruses only] and dirty conditions (3.0 g/l BSA + 3.0 ml/l erythrocytes) as an interfering substance for defined contact times (minimum 15 s). Rotavirus was tested without protein load. A ≥ 5 log10 (99.999%) decrease of bacteria and ≥ 4 log10 (99.99%) reduction in viral titre represented effective bactericidal and virucidal activity, respectively, per European standards. Results: PVP-I gargle/mouthwash diluted 1:30 (equivalent to a concentration of 0.23% PVP-I) showed effective bactericidal activity against Klebsiella pneumoniae and Streptococcus pneumoniae and rapidly inactivated SARS-CoV, MERS-CoV, influenza virus A (H1N1) and rotavirus after 15 s of exposure. Conclusion: PVP-I 7% gargle/mouthwash showed rapid bactericidal activity and virucidal efficacy in vitro at a concentration of 0.23% PVP-I and may provide a protective oropharyngeal hygiene measure for individuals at high risk of exposure to oral and respiratory pathogens. Funding: Mundipharma Research GmbH & Co. KG (MRG).
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Introduction Since the first case of Middle East Respiratory Syndrome coronavirus (MERS-CoV) infection was reported in 2012, the virus has infected more than 1300 individuals in 26 countries, and caused more than 480 deaths. Human-to-human transmission requires close contact, and has typically occurred in the healthcare setting. Improved global awareness, together with improved hygiene practices in healthcare facilities, has been highlighted as key strategies in controlling the spread of MERS-CoV. This study tested the in vitro efficacy of three formulations of povidone iodine (PVP-I: 4% PVP-I skin cleanser, 7.5% PVP-I surgical scrub, and 1% PVP-I gargle/mouthwash) against a reference virus (Modified vaccinia virus Ankara, MVA) and MERS-CoV. Methods According to EN14476, a standard suspension test was used to assess virucidal activity against MVA and large volume plating was used for MERS-CoV. All products were tested under clean (0.3 g/L bovine serum albumin, BSA) and dirty conditions (3.0 g/L BSA + 3.0 mL/L erythrocytes), with application times of 15, 30, and 60 s for MVA, and 15 s for MERS-CoV. The products were tested undiluted, 1:10 and 1:100 diluted against MVA, and undiluted against MERS-CoV. Results A reduction in virus titer of ≥4 log10 (corresponding to an inactivation of ≥99.99%) was regarded as evidence of virucidal activity. This was achieved versus MVA and MERS-CoV, under both clean and dirty conditions, within 15 s of application of each undiluted PVP-I product. Conclusion These data indicate that PVP-I-based hand wash products for potentially contaminated skin, and PVP-I gargle/mouthwash for reduction of viral load in the oral cavity and the oropharynx, may help to support hygiene measures to prevent transmission of MERS-CoV. Funding Mundipharma Research GmbH & Co.
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The shedding of severe acute respiratory syndrome coronavirus (SARS-CoV) into saliva droplets plays a critical role in viral transmission. The source of high viral loads in saliva, however, remains elusive. Here we investigate the early target cells of infection in the entire array of respiratory tissues in Chinese macaques after intranasal inoculations with a single-cycle pseudotyped virus and a pathogenic SARS-CoV. We found that angiotensin-converting enzyme 2-positive (ACE2+) cells were widely distributed in the upper respiratory tract, and ACE2+ epithelial cells lining salivary gland ducts were the early target cells productively infected. Our findings also have implications for SARS-CoV early diagnosis and prevention.
A prospective study was conducted to investigate the effect of long term therapy with two iodine-containing mouth rinses on thyroid function. Two groups of subjects were treated daily for 6 months with either a 5% polyvinylpyrrolidone (PVPI)-1.5% H2O2 mixture (Perimed) or a 5% PVPI-water mixture. Thyroid function studies, serum iodine concentrations, and urinary iodine excretion were measured before treatment, at 6-week intervals during the 6-month treatment period, and 3 weeks after the last treatment. There was evidence of significant iodine absorption (elevated serum total iodine and inorganic iodide concentrations and urinary iodine excretion) from daily use of both Perimed and the PVPI-water mixture. Serum T3 and T4 concentrations and the free T4 index did not change. There was a small significant rise in serum TSH concentrations during mouth rinse therapy, but all values remained within the normal range. This small increase in serum TSH is a normal adaptive response to the antithyroid effect of increased iodine intake and accounts for the maintenance of normal serum T4 and T3 concentrations. While daily use of these iodine-containing mouth rinses does result in significant iodine absorption, there is no evidence for the development of thyroid dysfunction during a 6-month course of therapy.
Recent confirmation of intrinsic bacterial contamination of 10% povidone-iodine solution has raised questions regarding the bactericidal mechanism of iodophors and the possibility for survival of vegetative bacterial cells in iodophor solutions. In this laboratory investigation, five different species were exposed to various dilutions of three commercial preparations of 10% povidone-iodine solution; survival was assessed after exposure for time periods varying between 0 and 8 min. All brands of povidone-iodine solution tested demonstrated more rapid killing of Staphylococcus aureus and Mycobacterium chelonei at dilutions of 1:2, 1:4, 1:10, 1:50, and 1:100 than did the stock solutions, S. aureus survived a 2-min exposure to full-strength povidone-iodine solution but did not survive a 15-s exposure to a 1:100 dilution of the iodophor. Both stock and dilute preparations of 10% povidone-iodine solution demonstrated rapid bactericidal action against Klebsiella pneumoniae, Pseudomonas cepacia, and Streptococcus mitis.