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A Novel Anti-Influenza Copper Oxide Containing Respiratory Face Mask

Authors:
  • Argaman Technologies Ltd.

Abstract and Figures

Background: Protective respiratory face masks protect the nose and mouth of the wearer from vapor drops carrying viruses or other infectious pathogens. However, incorrect use and disposal may actually increase the risk of pathogen transmission, rather than reduce it, especially when masks are used by non-professionals such as the lay public. Copper oxide displays potent antiviral properties. A platform technology has been developed that permanently introduces copper oxide into polymeric materials, conferring them with potent biocidal properties. Methodology/principal findings: We demonstrate that impregnation of copper oxide into respiratory protective face masks endows them with potent biocidal properties in addition to their inherent filtration properties. Both control and copper oxide impregnated masks filtered above 99.85% of aerosolized viruses when challenged with 5.66+/-0.51 and 6.17+/-0.37 log(10)TCID(50) of human influenza A virus (H1N1) and avian influenza virus (H9N2), respectively, under simulated breathing conditions (28.3 L/min). Importantly, no infectious human influenza A viral titers were recovered from the copper oxide containing masks within 30 minutes (< or = 0.88 log(10)TCID(50)), while 4.67+/-1.35 log(10)TCID(50) were recovered from the control masks. Similarly, the infectious avian influenza titers recovered from the copper oxide containing masks were < or = 0.97+/-0.01 log(10)TCID(50) and from the control masks 5.03+/-0.54 log(10)TCID(50). The copper oxide containing masks successfully passed Bacterial Filtration Efficacy, Differential Pressure, Latex Particle Challenge, and Resistance to Penetration by Synthetic Blood tests designed to test the filtration properties of face masks in accordance with the European EN 14683:2005 and NIOSH N95 standards. Conclusions/significance: Impregnation of copper oxide into respiratory protective face masks endows them with potent anti-influenza biocidal properties without altering their physical barrier properties. The use of biocidal masks may significantly reduce the risk of hand or environmental contamination, and thereby subsequent infection, due to improper handling and disposal of the masks.
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A Novel Anti-Influenza Copper Oxide Containing
Respiratory Face Mask
Gadi Borkow
1
*, Steve S. Zhou
2
, Tom Page
1
, Jeffrey Gabbay
1
1Cupron Scientific, Modi’in, Israel, 2Microbiotest, Microbac Laboratories, Inc. Sterling, Virginia, United States of America
Abstract
Background:
Protective respiratory face masks protect the nose and mouth of the wearer from vapor drops carrying viruses
or other infectious pathogens. However, incorrect use and disposal may actually increase the risk of pathogen transmission,
rather than reduce it, especially when masks are used by non-professionals such as the lay public. Copper oxide displays
potent antiviral properties. A platform technology has been developed that permanently introduces copper oxide into
polymeric materials, conferring them with potent biocidal properties.
Methodology/Principal Findings:
We demonstrate that impregnation of copper oxide into respiratory protective face
masks endows them with potent biocidal properties in addition to their inherent filtration properties. Both control and
copper oxide impregnated masks filtered above 99.85% of aerosolized viruses when challenged with 5.6660.51 and
6.1760.37 log
10
TCID
50
of human influenza A virus (H1N1) and avian influenza virus (H9N2), respectively, under simulated
breathing conditions (28.3 L/min). Importantly, no infectious human influenza A viral titers were recovered from the copper
oxide containing masks within 30 minutes (#0.88 log
10
TCID
50
), while 4.6761.35 log
10
TCID
50
were recovered from the
control masks. Similarly, the infectious avian influenza titers recovered from the copper oxide containing masks were
#0.9760.01 log
10
TCID
50
and from the control masks 5.0360.54 log
10
TCID
50
. The copper oxide containing masks
successfully passed Bacterial Filtration Efficacy, Differential Pressure, Latex Particle Challenge, and Resistance to Penetration
by Synthetic Blood tests designed to test the filtration properties of face masks in accordance with the European EN
14683:2005 and NIOSH N95 standards.
Conclusions/Significance:
Impregnation of copper oxide into respiratory protective face masks endows them with potent
anti-influenza biocidal properties without altering their physical barrier properties. The use of biocidal masks may
significantly reduce the risk of hand or environmental contamination, and thereby subsequent infection, due to improper
handling and disposal of the masks.
Citation: Borkow G, Zhou SS, Page T, Gabbay J (2010) A Novel Anti-Influenza Copper Oxide Containing Respiratory Face Mask. PLoS ONE 5(6): e11295.
doi:10.1371/journal.pone.0011295
Editor: John E. Tavis, Saint Louis University, United States of America
Received March 9, 2010; Accepted June 1, 2010; Published June 25, 2010
Copyright: ß2010 Borkow et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The study was funded by Cupron Scientific, a company that conducts research and development of medical devices using copper oxide as the active
ingredient. Cupron Scientific developed the antiviral mask, and had a role in the study design and decision to publish and preparation of the manuscript.
Competing Interests: Gadi Borkow, Tom Page and Jeffrey Gabbay work at Cupron Scientific, who produced the antiviral mask and funded the work.
The introduction of copper oxide into polymeric materials has been patented. The antiviral mask has received CE approval as a medical device and
will be eventually marketed. The authors confirm that this does not alter their adherence to all the PLoS ONE policies on sharing data and materials.
Steve S. Zhou is the Director of Virology and Molecular Biology at Microbiotest, the company that performed the actual GLP testing and analysis of
the data.
* E-mail: gadi@cupron.com
Introduction
Since the turn of the 20
th
century, when the presence of bacteria
in droplets from the nose and mouth was discovered along with
their role in disease transmission, masks have been used to protect
both health care providers and patients from respiratory diseases.
Surgical masks are used mainly during surgery to catch the
bacteria shed in liquid droplets and aerosols from the wearer’s
mouth and nose, and to protect the wearer from possible blood
splashes. In addition to health care facilities, simple, inexpensive
masks, which are similar in appearance to surgical masks, are
frequently worn in crowded areas. For example, such masks were
widely used, especially in China, Hong Kong, Vietnam, and
Toronto, Canada, during outbreaks of the SARS virus, during the
2007 avian bird flu pandemic in Japan and, more recently, in the
United States and Mexico City during the 2009 H1N1 flu (swine
flue) outbreak. The use of protective masks has been shown to
reduce the spread of respiratory viruses, especially when used by
individuals in enclosed spaces or in close contact with a person
with influenza-like symptoms [1,2]. The USA Centers for Disease
Control and Prevention (CDC) and the USA Occupational Safety
and Health Administration, among others, have recommended
their use to patients and health care providers [3–5]. Most of these
masks contain a nonwoven layer that, based on its pore size,
prevents the passage of pathogens through the mask, either from
the environment to the wearer or from the wearer to the
environment. Protective respiratory masks differ from respirators,
which are devices widely used in industry to protect the wearer
from noxious gases, vapors, and aerosols or to supply oxygen or
doses of medication to the wearer. It is important to be aware that
not all protective masks, especially those with exhalation valves,
prevent passage of pathogens from the wearer to the environment.
PLoS ONE | www.plosone.org 1 June 2010 | Volume 5 | Issue 6 | e11295
Furthermore, not all N95 respirators, especially those with
exhalation valves, prevent passage of pathogens from the wearer
to the environment. This is especially critical in a health care
setting where a surgical respirator (a hybrid between a surgical
mask and a respirator) would be needed, requiring both NIOSH
and FDA approval.
The use of protective masks by the wide public received
significant impetus from the World Health Organization’s (WHO)
declaration regarding a global flu pandemic on the 11
th
of June
2009. This declaration came in the wake of the geographic spread
of a new human influenza A H1N1 virus strain, with genes derived
from human (PB1), avian (PA and PB2), classical swine (HA, NP
and NS) and Eurasian swine (NA and M) influenza viruses [6–8].
This strain appears to have circulated in swine for years [9].
However, the efficacy of such masks is dependent on their
proper use and disposal, since incorrect use and disposal may
actually increase the risk of pathogen transmission, rather than
reduce it [10]. The fact that healthcare workers (including doctors
and nurses) have not always complied with safe disposal and
handling practices, even after prolonged instruction on these
practices [11,12], is of grave concern. For example, poor hygiene
practices by healthcare professionals, such as failure to wash the
hands with sufficient rigor and frequency, is one of the main
sources of nosocomial infections [13,14]. Furthermore, the risks of
pathogen transmission due to improper disposal and mishandling
may be even greater when these masks are used by non-
professionals such as the lay public [15], as is the case in the
current influenza pandemic.
Copper has potent biocidal properties [16,17]. For example,
copper inactivates bacteriophages [18], bronchitis virus [19],
poliovirus [18,20], herpes simplex virus [20,21], human immuno-
deficiency virus (HIV) [22–25] and influenza viruses [26,27].
Recently a durable platform technology was developed, which
introduces copper oxide to textile fibers, latex and other polymer
products [24,28]. The copper oxide impregnated products possess
broad-spectrum anti-microbial properties [24,28,29] including
antiviral properties [24,25,30].
In the present report we demonstrate that the impregnation of
copper oxide into disposable N95 respiratory masks (masks that
filter 95% of 0.3 micron particles) endows them with potent anti-
influenza biocidal properties without altering their physical barrier
properties.
Materials and Methods
Masks
US National Institute for Occupational Safety and Health
(NIOSH) N95 face masks containing copper oxide particles,
hereafter referred to as test masks, were composed of the following
4 layers (Figure 1a): a) external layer A, made of spunbond
polypropylene fabric containing 2.2% weight/weight (w/w)
copper particles (Figure 1b); b) internal layer B, made of
meltblown polypropylene fabric containing 2% w/w copper oxide
particles (Figure 1c), which constitutes the barrier layer that
provides the physical filtration properties to the mask; c) internal
layer C, made of plain polyester, designed to give shape to the
mask; and d) external layer D, which is identical to layer A, but is
closest to the face of the wearer when the mask is used. Similar
NIOSH N95 face masks, without copper oxide particles, were
used as control masks and are hereafter referred to as control
masks. The external layers A and D of these masks were made of
spunbond polypropylene without impregnated copper oxide
particles and the internal layer B was made from meltblown
polypropylene without impregnated copper oxide particles.
Internal layer C, made of plain polyester, was identical to that
used in the test masks to give shape to the masks. The control and
test masks were sterilized by gamma radiation.
Challenge virus
Human influenza A virus (A/Puerto Rico/8/34 (H1N1)) and
avian influenza virus (Turkey/Wis/66 (H9N2)) were purchased
from Charles River Laboratories (Storrs, Connecticut, USA). The
viral stocks were stored at 260uCto290uC. Frozen viral stocks
were thawed on the day of the test and diluted to a challenge
concentration of $10
6
infectious units/mL.
Challenge of mask with aerosolized virus. Three control
and 3 test masks were challenged with aerosolized human
influenza A virus (H1N1) or aerosolized avian influenza virus
(H9N2) based on the ASTM Method F 2101.01 ‘‘Standard Test
Methods for Evaluating the Bacterial Filtration Efficiency of
Figure 1. Copper oxide impregnated test mask composition. a) The test mask was composed of 2 external spunbond polypropylene layers (A
and D) containing 2.2% copper oxide particles (weight/weight), one internal meltblown polypropylene layer (B) containing 2% copper oxide particles
(w/w) and one polyester layer containing no copper oxide particles. b) Scanning electronic microscope picture and X-ray analysis of external layer A.
c) Scanning electronic microscope picture and X-ray photoelectron spectrum analysis of internal layer B.
doi:10.1371/journal.pone.0011295.g001
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PLoS ONE | www.plosone.org 2 June 2010 | Volume 5 | Issue 6 | e11295
Medical Face Mask Materials, Using a Biological Aerosol of
Staphylococcus aureus,’’ after customizing the method for virus
testing. Briefly, test masks preconditioned to a temperature of
25uC and a relative humidity of $85% for 4 hours were
hermetically clamped between a single stage Anderson impactor
(Thermo Electron Corporation, Franklin, Massachusetts, USA)
and an aerosol chamber under sterile conditions (Figure 2).
Approximately 25 mL of human influenza A virus and avian
influenza virus, respectively, were aerosolized (mean particle size:
3.0 mm60.3 mm per manufacturer) by using a 6-jet nebulizer (BGI
Incorporated, Waltham, MA USA). They were introduced into
the aerosol chamber by using an upstream air compressor for
1 minute and a downstream vacuum pump attached to the
impactor creating 28.3 L/min air flow through the masks. After
the 1-minute challenge, the air compressor was terminated and the
residual aerosol droplets were drawn through the masks for an
additional 2 minutes. The aerosol droplets which penetrated the
tested masks were collected from the upper surface of the stage
using a flush media (Earle’s Balanced Salt Solution (EBSS) +5%
Newborn calf serum) and a collecting petri dish placed underneath
the stage which contained semi-solid collection media (Sterile
deionized water +5% gelatin +2% Bovine Serum Albumin). The
semi-solid collection media were combined with the flush media
and liquefied at 3662uC for ,15 minutes and the viral titers were
determined by titration assay as detailed below. After 30 minutes
the masks were aseptically removed from the impactor and
transferred aseptically to a sterile stomacher bag containing 20 mL
extraction medium (EBSS +5% Newborn calf serum). After
stomaching, the extraction medium was transferred to appropriate
sterile tubes and the infectious viral titers were determined as
detailed below.
All media and equipment, including the impactor, nebulizer,
scissors and forceps, were steam sterilized. All tests were conducted
under a biological safety cabinet, disinfected with 70% ethanol
followed by UV radiation prior to the introduction of the aerosol
challenge apparatus and prior to the commencement of the
experiments.
Determination of infectious titers. The infectious virions
of each aerosol challenge as well as the retrieved virions from the
control and test masks were first determined by performing ten-
fold serial dilutions of each viral sample. Selected dilutions were
then inoculated intra-allantoically in embryonated chicken eggs at
0.2 ml per egg and incubated for 2–4 days at 3662uC. Four
replicate embryonated eggs were inoculated per dilution tested for
the titration samples. Forty replicate embryonated eggs were
inoculated at the lowest dilution for the large volume samples (see
below).
Following completion of the incubation period, the eggs were
candled to determine viability of the embryo and then placed at 2–
8uC for a minimum of 8 hours. Afterwards, the allantoic fluid was
harvested and reserved at 210uC for further evaluation. These
reserved allantoic samples were then assayed for the presence of
virus using standard hemagglutination assay using chicken red
blood cells.
The 50% Embryo Infectious Dose per ml (EID
50
/ml),
equivalent to 50% Tissue Culture Infectious Dose per ml
(TCID
50
/ml) in the context of this study, of the virus was
determined based on the Spearman-Karber method [31].
Large volume samplings (International Conference on Harmo-
nization (ICH), 1997; Darling, 2002) were used to increase the
lower limit of detection of the infectious titers. The increase in
sensitivity can be explained as follows: when samples contain a
very low virus concentration, there is a discrete probability that
since only a fraction of the samples is tested for virus infectivity,
that fraction may test negative due to the random distribution of
viruses throughout the total sample. The probability, p, that the
Figure 2. Viral aerosol challenge test apparatus scheme. Key: 1. High pressure air source; 2. Filter; 3. Nebulizer; 4. Aerosol chamber; 5. Test
material chamber; 6. Anderson impactor; 7. Filter; 8. Calibrated flow meter; 9. Filter; 10. 4L vacuum flask; 11. Filter; 12. 4L vacuum flask; 13. Filter; 14.
Vacuum pump.
doi:10.1371/journal.pone.0011295.g002
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PLoS ONE | www.plosone.org 3 June 2010 | Volume 5 | Issue 6 | e11295
sample analyzed did not contain infectious viruses is expressed by:
p = [(V2v)/V]
y
, where V is the total volume of the container, v is
the volume of the fraction being tested, and y is the absolute
number of infectious viruses randomly distributed in the sample. If
V is sufficiently large relative to v, the Poisson distribution can
approximate p:
P~e
{cv or c~{½Ln(P)=v
Where c is the concentration of infectious virus and v is the total
sample volume. The amount of viruses which would have to be
present in the total sample in order to achieve a positive result with
95% confidence (p = 0.05) is calculated as
c~{½Ln(0:05)=v~3=v
If all n replicate eggs were negative, the virus titer after the process
was considered to be less than or equal to this value. The total
volume of samples assayed was v = v9nd, where v9is the test
volume in a replicate, n is the number of replicates per sample,
and d is the sample dilution.
A one way ANOVA and Turkey Test were used to compare
between the treatments using SigmaStat 2.0 (Jandel Scientific,
Richmond, CA, USA).
Physical Barrier and Material Properties Tests
The following standard tests designed to test the filtration
properties of face masks were performed by Nelson Laboratories,
Inc, Salt Lake City Utah: Bacterial Filtration Efficacy (BFE) Test,
Differential Pressure (DP) Test, Latex Particle Challenge Test and
Resistance to Penetration by Synthetic Blood Test. All tests were
performed using GLP procedures and in accordance with ASTM
F2100-07 (Standard Specification for Performance of Materials
Used in Medical Face Masks. ASTM International, West
Conshohocken, PA), ASTM F2101-07 (Test Method for Evalu-
ating the Bacterial Filtration Efficiency of Medical Face Masks
Materials, Using a Biological Aerosol of Staphylococcus aureus.
ASTM International, West Conshohocken, PA), ASTM F2299-03
(Standard Test Method for Determining the Initial Efficiency of
Materials Used in Medical Face Masks to Penetration by
Particulates Using Latex Spheres. ASTM International, West
Conshohocken, PA), ASTM F1862-07 (Standard Test Method for
Resistance of Medical Face Masks to Penetration by Synthetic
Blood, ASTM International, West Conshohocken, PA) and the
European EN 14683:2005, CEN/TC 205 standard (Surgical
Masks – Requirements and Test Methods. European Committee
for Standardization, Brussels, Belgium).
Bacterial Filtration Efficacy (BFE) Test. Filtration
efficiency of bacterial particles is determined by comparing the
challenge collected downstream of the mask sample with the
known challenge delivered upstream of the mask sample. Testing
was conducted both as directed in Annex B of the EN 14683:2005
standard and in compliance with ASTM F2101. Briefly, a culture
of Staphylococcus aureus ATCC #6538 (designation FDA 209 strain)
was diluted in 1.5% peptone water to a concentration to yield
challenge levels of 22006500 colony forming units (CFU) per test
sample. The bacterial culture suspension was pumped through a
‘Chicago’ nebulizer at a controlled flow rate and fixed air pressure
(28.3 L/min; 1 cubic foot/min). The constant challenge delivery
at a fixed air pressure formed aerosol droplets with a mean particle
size (MPS) of 3.0 mm. The aerosol droplets were generated in a
glass aerosol chamber and drawn through a six-stage, viable
particle, Anderson sampler (Andersen 2000 Inc., Atlanta, GA) for
collection. According to the EN 14683:2005 standard, samples
were conditioned at 2062uC and a relative humidity of 6562%
for 4 hours prior to testing. Separate samples were conditioned for
4 hours at 2165uC and a relative humidity of 8565% prior to
testing, according to ASTM F2101. Test samples, positive controls
and reference material received a one minute challenge followed
by a one minute vacuum cycle. The samples were tested at normal
room temperature. The outside surface of each mask sample faced
the challenge aerosol. The area of each sample tested was
,3.0 inches (75 mm) in diameter. The delivery rate of the
challenge produced a consistent challenge level of 22006500 CFU
on the test control plates. A test control (no filter medium in the air
stream) and reference material were included at the beginning and
after the last test sample. A negative control run (without addition
of bacterial challenge) was also performed. The Andersen sampler,
a sieve sampler, impinged the aerosol droplets onto six soybean
casein digest agar (SCDA) plates based on the size of each droplet.
The agar plates were incubated at 3762uC for 4864 hours and
the colonies formed by each bacteria laden aerosol droplet were
counted and converted to probable hit values using the hole
conversion chart provided by Andersen. These converted counts
were used to determine the average challenge level delivered to the
test samples. The distribution ratio colonies for each of the six agar
plates were used to calculate the MPS of the challenge aerosol.
The filtration efficacies were calculated as a percent difference
between the test sample runs and the control average using the
following equation: % BFE = (C 2T)/C6100, where C = average
of control values, and T = count of total for test material.
Differential Pressure (DP) Test. This test measures the
difference in pressure through a test mask by comparing the air
pressure downstream of the test mask with a known pressure
upstream of the test mask. Testing was conducted as directed in
Annex C of EN 14683:2005. Briefly, the DP test measured the
differential air pressure on either side of the test sample using a
manometer differential upstream and downstream of the test
material, at a constant flow rate. Test samples were conditioned at
2062uC and a relative humidity of 6562% for 4 hours prior to
testing. Separate samples were conditioned for 4 hours at 2165uC
and a relative humidity of 8565% prior to testing. Testing was
conducted at a flow rate of 8 liters per minute (Lpm)(volumetric).
This value represents a corrected flow rate, which compensates for
temperature and altitude differences. At least one reference
material was included with each set of test samples. The DP was
calculated using the following equation: DP = M/test area, where
M = average mm water of test replicates. The sampler holder used
in the DP test has a test area of 4.9 cm
2
. The DP value is expressed
in mm of water/cm
2
of test area when testing according to ASTM
and as Pa/cm
2
when testing according to CEN.
Latex Particle Challenge Test. This test is designed to
evaluate pass through of very small aerosol particles (sizes between
0.1 and 5.0 microns) through the masks. The test was conducted
according to ASTM F2299 in an ISO Class 5 (class 100) HEPA
filtered hood. Monodispersed polystyrene (latex) microspheres of a
particle size of 0.09760.003 mm were obtained from Duke
Scientific, Palo Alto, CA. These particles were nebulized, dried,
and passed through the test masks. The particles passing through
the test masks were enumerated using a laser particle counter.
Three one-minute counts were determined for each mask sample
and the results averaged. Three one-minute control counts were
performed, without a test sample in the system, before and after
each test sample run. More specifically, an aliquot of the latex
spheres was transferred to particle free USP water and then
atomized using a Particle Measuring System (PMS) Model PG-100
generator. The latex aerosol was mixed with additional filtered,
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dried air and passed through the test system. The flow rate
through the test system was maintained at 1 cubic foot per meter
(CFM)65%. The particles delivered were collected and
enumerated using a PS lased based particle counter. Extraneous
particulate ‘‘background noise’’ through the sample holder
produced an average of ,1 particle at 1 CFM with the
nebulizer output clamped off. A mask sample was placed into
the sample holder, the system was allowed to stabilize, and then
triplicate one-minute counts were recorded. Control count
averages were maintained at a level of 10,000–15,000 particles
per cubic foot. The percent filtration efficacy for the sample was
determined using the following equation: %FE = (Average
C2Average T)/Average C, where C = particle counts with no
test sample in system, and T =particle counts with test sample in
system.
Resistance to Penetration by Synthetic Blood. This
procedure simulates an arterial spray and then evaluates the
capacity of the material to protect the user from possible exposure
to blood and other body fluids. The penetration of synthetic blood
through 32 mask replicates was determined visually in compliance
with ASTM F 1862. The 32 mask samples were conditioned for
4 hours at 2165uC and a relative humidity of 8565%. A clean
canula was fixed onto the front of a valve and a reservoir was filled
with synthetic blood. Each sample was tested within one minute of
removing it from conditioning. Each face mask was mounted on
the specimen holding fixture and positioned 305 mm (12 in.) from
the canula. The mask was then subjected to the 2 ml volume spray
at a pressure of 160 mm Hg, which moved from the canula in a
horizontal path perpendicular to the face mask. The lab conditions
during testing were a temperature of 23uC and a relative humidity
of 28%. At the conclusion of the test, the backside of the mask was
observed for synthetic blood penetration. The Acceptable Quality
Level of this test at 120 mm Hg is 4.0%, i.e., at least 31 of the 32
masks tested needed to show no passage of synthetic blood through
them.
Results
Controls
Toxicity/Negative Control. Aerosolized media containing
no viruses were tested using the exact same test conditions
described above in the Materials and Methods section in the
absence or presence of the control and test masks secured between
the sampler and aerosol chamber. Post aerosol challenge, the
media were collected and diluted as described above and selected
dilutions were inoculated into host egg embryos and incubated in
the same manner as the rest of the test and control samples. As
expected, no infectious virus was detected in the presence or
absence of the control and test masks.
Virus Recovery Control. Human influenza A virus and
avian influenza virus aliquots, containing 6.9560.25 and
7.9660.25 log
10
TCID
50
units per ml (titer 6confidence limit
[CL]), respectively, were used per this and subsequent tests. The
average volume of the aerosolized virus delivered per run was
,0.3 ml. The infectious titers that could be retrieved in the
absence of any mask or barrier between the sampler and aerosol
chamber, determined as described in the Materials and Methods
section, were 5.6660.51 and 6.1760.37 log
10
TCID
50
units for
human influenza A and avian influenza virus, respectively. Thus
all viral reduction calculations were based on these viral recovery
control titers.
Host viability/media sterility control. Eight eggs were
inoculated with an appropriate medium during the incubation
phase of the study. This control demonstrated that the eggs
remained viable throughout the course of the assay period. In
addition, it confirmed the sterility of the media employed
throughout the assay period.
Neutralizer effectiveness control. Atestmaskwas
challenged with mock inoculum (Earle’s Balanced Salt Solution)
and then put in sterile stomacher bags containing 20 mL
extraction medium. After stomaching, the extraction medium
was serially diluted ten-fold. Then a low level of virus
(approximately 1,000 log
10
TCID
50
units) was added to 4.5 mL
of each dilution of the extraction medium (2.3 log
10
TCID
50
units/mL). A 0.2-mL aliquot was inoculated into the host eggs as
detailed in section 2.4. Infectious virus was observed in all
dilutions of the extracted sample, indicating that no copper or
other molecules eluted from the test masks that significantly
affected subsequent influenza infection and replication in the host
eggs.
Viral Filtration by the Mask
The number of infectious human influenza A virus and avian
influenza virus titers that passed through the masks (referred to as
‘‘pass through’’) are shown in Table 1. Both test and control
masks reduced the infectious titers that pass through the masks by
,3 logs (2.9161.19 and 3.5561.14, respectively) for human
influenza A virus and by ,4 logs (4.3560.95 and 4.1260.64,
respectively) for the avian influenza virus. No statistical significant
differences between the filtration efficiencies of the test and
control masks of human influenza A virus and avian influenza
virus were found.
Deactivation of virus remaining in the copper oxide
impregnated masks
The number of infectious human influenza A virus and avian
influenza virus titers recovered from the control and test masks
30 minutes after their challenge with the virus (referred to as
‘‘mask retrieved’’) are shown in Table 2. In contrast to the
filtration efficiencies of the test and control masks, there was a
statistically significant higher direct contact inactivation of both
the human influenza A virus and avian influenza virus by the test
masks than by the control masks. The infectious human influenza
A and avian influenza virus titers in the test masks were reduced by
$4.7860.88 log and 5.2060.84 log, respectively. In contrast, the
human influenza A and avian influenza virus infectious titers were
reduced via direct contact by the control masks by 1.9061.03 log
and 1.3460.84 log, respectively. The differences in the retrieved
infectious titers between the test and control masks were $2.88 log
for human influenza A (p,0.01 by ANOVA and p,0.05 by
Turkey Test) and 3.13 log for the avian influenza virus (p,0.05 by
both ANOVA and Turkey Test).
Filtration performance of the masks
Table 3 details the results obtained with the Bacterial Filtration
Efficacy (BFE), Differential Pressure (DP) and Latex Particle
Challenge standard test methods widely used in the mask industry
to determine the filtration efficacy of masks. The filtration
performance of the copper oxide impregnated masks met the
acceptance criteria as type IIR respiratory masks, as listed in
Table 1, section 5.2.3 of the EN 14683:2005 standard, and as
NIOSH N-95, as follows: %BFE = $98%; DP=,49 Pa/cm
2
and
,5.0 mm H
2
O/cm
2
. In addition, blood penetration was not
observed in any of the 32 masks subjected to a 2 minute spray of
synthetic blood at a pressure of 160 mm Hg. This pressure is even
higher than the 120 mm Hg pressure threshold of blood splash
resistance required by the EN 14683:2005 standard.
Antiviral Respiratory Mask
PLoS ONE | www.plosone.org 5 June 2010 | Volume 5 | Issue 6 | e11295
Discussion
Based on a recently developed platform technology [24,28],
copper oxide particles were incorporated into 3 of 4 non-woven layers
that comprise N-95 respiratory masks or Type IIR FFP1-level
medical/patient respiratory masks. As demonstrated here in tests
designed to simulate consumer use, the inclusion of the copper oxide
particles in N-95 respiratory masks did not alter their physical
filtration properties (Tables 1 and 3), but did endow them with the
capacity to readily kill the virions that remain in the mask (Table 2).
This is of major significance as the high viral titers that remain
infectious in regular masks, as demonstrated in the control masks used
in this study, can be a source of viral transmission both to the mask
wearers and to others, as recently pointed out by the WHO [10].
Table 2. Mask Retrieved
a
Infectious Titers.
Sample Virus Initial Load (log
10
TCID
50
) Output Load (log
10
TCID
50
) Log
10
Reduction
Test Mask 1 H1N1 5.65960.51 #0.87 $4.7860.51
Test Mask 2 H1N1 5.65960.51 #0.90 $4.75760.51
Test Mask 3 H1N1 5.65960.51 #0.88 $4.7760.51
Average $4.7760.88
Control Mask 1 H1N1 5.6660.51 4.7060.32 0.95960.60
Control Mask 2 H1N1 5.6660.51 3.3060.31 2.3660.60
Control Mask 3 H1N1 5.6660.51 6.0060.28 20.3460.58
Average 1.9061.03
Test Mask 1 H9N2 6.16960.37 0.9860.31 5.1960.48
Test Mask 2 H9N2 6.16960.37 #0.97 $5.2060.37
Test Mask 3 H9N2 6.16960.37 0.9760.44 5.2060.57
Average 5.2060.84
Control Mask 1 H9N2 6.1660.37 4.5060.00 1.6660.37
Control Mask 2 H9N2 6.1760.37 5.0060.35 1.1760.51
Control Mask 3 H9N2 6.16960.37 5.5860.41 0.5960.55
Average 1.3460.84
a
The viral load from the large volume inoculation was used as the viral load of the mask retrieved sample, since the large volume technique provides a more sensitive
determination method when virus concentration was lower than the detection limit of the titration method.
doi:10.1371/journal.pone.0011295.t002
Table 1. Pass Through
a
Infectious Titers.
Sample Virus Initial Load (log
10
TCID
50
) Output Load (log
10
TCID
50
) Log
10
Reduction
Test Mask 1 H1N1 5.6660.51 2.4260.59 3.2460.78
Test Mask 2 H1N1 5.6660.51 3.4060.28 2.2660.58
Test Mask 3 H1N1 5.6660.51 2.9260.45 2.7461.19
Average 2.9161.19
Control Mask 1 H1N1 5.6660.51 2.6760.25 2.9960.57
Control Mask 2 H1N1 5.6660.51 2.2160.60 3.4560.78
Control Mask 3 H1N1 5.6660.51 1.8360.31 3.8360.60
Average 3.5561.14
Test Mask 1 H9N2 6.1760.37 2.2060.25 3.9760.45
Test Mask 2 H9N2 6.1760.37 2.6760.43 3.5060.57
Test Mask 3 H9N2 6.1760.37 1.4460.49 4.7360.61
Average 4.3560.95
Control Mask 1 H9N2 6.1760.37 4.9060.00 1.2760.37
Control Mask 2 H9N2 6.1760.37 1.5960.00 4.5860.37
Control Mask 3 H9N2 6.1760.37 2.9160.00 3.2660.37
Average 4.1260.64
a
Virus that passed through the masks were recovered from both the collection petri dish and the upper surface of the stage. Here the combined viral loads, calculated
by combining the viral loads from both fractions, are presented. In the cases where no virus was detected, the theoretical maximum possible load was included in the
combined load as a worst-case scenario.
doi:10.1371/journal.pone.0011295.t001
Antiviral Respiratory Mask
PLoS ONE | www.plosone.org 6 June 2010 | Volume 5 | Issue 6 | e11295
Development of a biocidal mask (and in general, all protective
personal equipment (PPE)) capable of rendering the pathogens
that come into contact with them non-infectious, may significantly
reduce pathogen transmission and contamination of the wearers
themselves and of the environment. This may happen when
healthcare workers touch their mask and then fail to wash their
hands properly or at all, or when they dispose of the mask without
proper safe disposal precautions. In addition to contamination
from poor hand-washing practices, there is evidence of other
problems such as pathogens shedding from surgical respirators
onto patients in the operating theater, increasing the risk of
nosocomial infections [32–36]. Additionally, the significantly
reduced viral load remaining on the mask should protect the
wearers from inhaling the virus during prolonged mask wearing.
The mechanisms of virus kill are achieved via the interaction of
copper ions with the virions that are entrapped in the mask or that
come into contact with the surface of the copper oxide
impregnated outer surfaces of the masks. The exact copper viral
kill mechanisms need to be deciphered. The capacity of copper
ions to render influenza virions, including H1N1 and H9N2
viruses, non-infective has already been demonstrated [26,27,30].
Interestingly, it was found that the infectivity of H9N2 virus was
reduced in a dose dependent manner at lower concentrations in
which neither neuraminidase (NA) nor hemagglutination inhibi-
tion occurred [26]. Electron microscopic analysis revealed
morphological abnormalities of the copper-treated H9N2 virus,
but the exact kill mechanism was not elucidated [26].
Importantly, in addition to the antiviral properties of the copper
oxide containing masks, the layers containing the copper oxide
also have potent antimicrobial properties (data not shown), in
accordance with the already reported broad-spectrum antimicro-
bial properties of fibers and fabrics containing copper oxide
[24,28,29]. A lesser infectious bacterial load in an antimicrobial
surgical respirator would at least reduce the risk of one potential
source of nosocomial infections.
Could the addition of copper oxide into the masks result in an
unsafe product for use? Several tests carried out in independent
laboratories using good laboratory practices, which are not
detailed in this report, have clearly shown that such is not the
case. The amount of copper that eluted to the air from the test
mask during 5 hours under simulated breathing conditions was
0.46760.47 pg, a level that is far below (.10
5
folds) the
respiratory copper permissible exposure limit (PEL) set by the
USA Occupational Safety and Health Administration (‘‘OSHA’’).
The lowest observed-adverse-effect levels (‘‘LOAELs’’) for chronic
copper inhalation exposure was determined to be 0.64 mg/m
3
[37]. Again, the copper levels eluted during the simulated
breathing test from the copper containing masks (0.09 pg/m
3
)
are a tiny fraction (.10
6
folds) of this copper LOAEL.
Even when simulating a worst case scenario, in which the masks
would be soaked in saliva, and all the saliva would be ingested, the
amount of copper eluted from the mask into the saliva was
,7.24 mg/hr (average of three replicates minus the background),
which is significantly lower than 20.8 mg/hr, the minimal risk level
(MRL) for oral exposure for a person weighing 50 kg.
Importantly, the outer layers of the masks, which contain
,2.2% copper oxide particles, did not cause any skin sensitization
or skin irritation as determined in animal studies (data not shown).
Also similar fabrics containing 6 times higher amounts of copper
oxide did not cause any skin irritation [28]. These findings are in
accordance with the very low risk of adverse skin reactions
associated with copper [38] and with the lack of any adverse toxic
irritations on the facial skin with ointments containing up to 20%
copper [39]. In addition, the copper oxide containing masks
passed flammability tests in accordance with US FDA (21 CFR
Part 58) regulations, as determined in an independent FDA
approved lab (Nelson Labs) using GLP.
In summary, we demonstrate that copper oxide impregnated
masks safely reduce the risk of influenza virus environmental
contamination without altering the filtration capacities of the
masks. Due to the potent antiviral and antibacterial properties of
copper oxide, we believe that these masks also confer protection
from additional pathogens, and, as such, are an important
additional armament in the combat against the spread of and
infection by dangerous pathogens. It should be pointed out that
the production of the mask layers with copper oxide and the
manufacture of the mask using these materials do not add any
significant costs to the price of the masks. It is suggested that
copper oxide should be also included in other personal protective
equipment to further confer protection to the wearer and to the
environment.
Author Contributions
Conceived and designed the experiments: GB SSZ TP. Performed the
experiments: SSZ. Analyzed the data: GB SSZ. Contributed reagents/
materials/analysis tools: JG. Wrote the paper: GB TP. Director of Virology
and Molecular Biology at Microbiotest, where the actual GLP testing was
conducted under a subcontract agreement: SSZ. Invented how to
permanently introduce copper oxide into fibers and designed the antiviral
mask: JG.
Table 3. Filtration performance of the masks
a
.
EN 14683:2005 ASTM F2101 ASTM F2299
Sample BFE (%) DP (Pa/cm
2
) BFE (%) DP(mmH
2
O/cm
2
) Average Sample Counts Average Control Counts Filtration Efficiency (%)
1.99.9 41.5 98.2 4.6 1310 10438 87
2.99.9
b
39.5 98.6 4.3 422 10434 96
3.99.9
b
41.1 98.5 4.3 565 11636 95.1
4 99.2 38.1 98.6 4.3 681 12426 94.5
5.99.9
b
39.5 98.7 4.2 544 11153 95.1
Mean 99.7 39.94 98.52 4.26 704 11217 93.54
±
SD 0.3 1.37 0.19 0.055 350 846 3.7
a
Each test was done using 5 replicate masks. The result for each of the replicate mask is shown.
b
There were no detected colonies on any of the Andersen sampler plates for this sample.
doi:10.1371/journal.pone.0011295.t003
Antiviral Respiratory Mask
PLoS ONE | www.plosone.org 7 June 2010 | Volume 5 | Issue 6 | e11295
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Antiviral Respiratory Mask
PLoS ONE | www.plosone.org 8 June 2010 | Volume 5 | Issue 6 | e11295
... The lack of performance of medical masks forced the global researchers to think about high-performance, reusable medical masks for the safety of both public and medical workers. One of the strategies to achieve this objective is to either modify surface of the fabric or apply a protective coating over the fabrics used in commercial face mask [11,12]. Another milestone in this area is the generation of a photo sterile mask by the utilization of photothermal effects of nanomaterials [13]. ...
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Background: On April 15 and April 17, 2009, novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in specimens obtained from two epidemiologically unlinked patients in the United States. The same strain of the virus was identified in Mexico, Canada, and elsewhere. We describe 642 confirmed cases of human S-OIV infection identified from the rapidly evolving U.S. outbreak. Methods: Enhanced surveillance was implemented in the United States for human infection with influenza A viruses that could not be subtyped. Specimens were sent to the Centers for Disease Control and Prevention for real-time reverse-transcriptase-polymerase-chain-reaction confirmatory testing for S-OIV. Results: From April 15 through May 5, a total of 642 confirmed cases of S-OIV infection were identified in 41 states. The ages of patients ranged from 3 months to 81 years; 60% of patients were 18 years of age or younger. Of patients with available data, 18% had recently traveled to Mexico, and 16% were identified from school outbreaks of S-OIV infection. The most common presenting symptoms were fever (94% of patients), cough (92%), and sore throat (66%); 25% of patients had diarrhea, and 25% had vomiting. Of the 399 patients for whom hospitalization status was known, 36 (9%) required hospitalization. Of 22 hospitalized patients with available data, 12 had characteristics that conferred an increased risk of severe seasonal influenza, 11 had pneumonia, 8 required admission to an intensive care unit, 4 had respiratory failure, and 2 died. The S-OIV was determined to have a unique genome composition that had not been identified previously. Conclusions: A novel swine-origin influenza A virus was identified as the cause of outbreaks of febrile respiratory infection ranging from self-limited to severe illness. It is likely that the number of confirmed cases underestimates the number of cases that have occurred.
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Copper has potent biocidal properties. Copper ions, either alone or in copper complexes, have been used for centuries to disinfect liquids, solids and human tissue. This manuscript reviews the biocidal mechanisms of copper and the current usages of copper and copper compounds as antibacterial, antifungal and antiviral agents, with emphasis on novel health related applications. These applications include the reduction of transmission of health-associated (nosocomial) pathogens, foodborne diseases, and dust mites loads and treatment of fungal foot infections and wounds. Possible future applications include filtration devices capable of deactivating viruses in solutions, such as contaminated blood products and breastmilk.
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Viral epidemics or pandemics of acute respiratory infections like influenza or severe acute respiratory syndrome pose a world-wide threat. Antiviral drugs and vaccinations may be insufficient to prevent catastrophe. To systematically review the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 2); MEDLINE (1966 to May 2009); OLDMEDLINE (1950 to 1965); EMBASE (1990 to May 2009); and CINAHL (1982 to May 2009). We scanned 2958 titles, excluded 2790 and retrieved the full papers of 168 trials, to include 59 papers of 60 studies. We included any physical interventions (isolation, quarantine, social distancing, barriers, personal protection and hygiene) to prevent transmission of respiratory viruses. We included the following study designs: randomised controlled trials (RCTs), cohorts, case controls, cross-over, before-after, and time series studies. We used a standardised form to assess trial eligibility. RCTs were assessed by: randomisation method; allocation generation; concealment; blinding; and follow up. Non-RCTs were assessed for the presence of potential confounders, and classified into low, medium, and high risks of bias. The risk of bias for the four RCTs, and most cluster RCTs, was high. The observational studies were of mixed quality. Only case-control data were sufficiently homogeneous to allow meta-analysis. The highest quality cluster RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children. Additional benefit from reduced transmission from children to other household members is broadly supported in results of other study designs, where the potential for confounding is greater. Six case-control studies suggested that implementing barriers to transmission, isolation, and hygienic measures are effective at containing respiratory virus epidemics. We found limited evidence that N95 respirators were superior to simple surgical masks, but were more expensive, uncomfortable, and caused skin irritation. The incremental effect of adding virucidals or antiseptics to normal handwashing to decrease respiratory disease remains uncertain. Global measures, such as screening at entry ports, were not properly evaluated. There was limited evidence that social distancing was effective especially if related to the risk of Physical interventions to interrupt or reduce the spread of respiratory viruses exposure. Many simple and probably low-cost interventions would be useful for reducing the transmission of epidemic respiratory viruses. Routine long-term implementation of some of the measures assessed might be difficult without the threat of a looming epidemic.
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We report the capacity of copper oxide-containing filters to reduce infectious titers of a panel of viruses spiked into culture media. Enveloped, nonenveloped, RNA, and DNA viruses were affected, suggesting the possibility of using copper oxide-containing devices to deactivate a wide spectrum of infectious viruses found in filterable suspensions.
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Abstract Since its identification in April 2009, an A (H1N1) virus containing a unique combination of gene segments from both North American and Eurasian swine lineages has continued to circulate in humans. The lack of similarity between the 2009 A (H1N1) virus ...
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This is the protocol for a review and there is no abstract. The objectives are as follows: To systematically review the evidence of effectiveness of interventions to interrupt or reduce the spread of respiratory viruses causing influenza-like illnesses (excluding vaccines and antivirals, which have already been covered by Cochrane Reviews) (Demicheli 2004; Jefferson 1999; Jefferson 2006b; Matheson 2003; Smith 2006; Swingler 2003). Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.