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August 5, 1988

Building-Associated Risk of Febrile Acute Respiratory Disease

JAMA. 1988;260(5):636. doi:10.1001/jama.1988.03410050051015

To the Editor.—  Brundage et al1 are to be commended on their fascinating study, although they may understate its importance. Transmission of viral disease through ventilation systems has indeed been well described, but only for measles, rubella, and varicella viruses. Common features of these three viruses include high primary and secondary attack rates. The reference cited by Brundage et al concerning influenza outbreaks in penal institutions and schools2 does not address the relationship of the epidemics with ventilation systems. Another reference3 refers to two outbreaks of allergic lung disease, one related to a central air washer4 and one to cafeteria flooding.5 Their own data are therefore the first, to my knowledge, to suggest an increased frequency of respiratory tract infections from common viruses related simply to mechanical ventilation.Two factors may contribute to the recirculation and viability of viruses in the indoor air, leading to