Jaumdally, S.Tomasicchio, M.Pooran, A.Esmail, A.Kotze, A.Meier, S.Wilson, L.Oelofse, S.Van der Merwe, C.Roomaney, A.Davids, M.Suliman, T.Joseph, R.Perumal, T.Scott, A.Shaw, M.Preiser, W.Williamson, C.Goga, Ameena EbrahimMayne, E.Gray, G.Moore, P.Sigal, A.Limberis, J.Metcalfe, J.Dheda, K.2025-02-262025-02-262024-03-05Jaumdally, S., Tomasicchio, M., Pooran, A. et al. 2024, 'Frequency, kinetics and determinants of viable SARS-CoV-2 in bioaerosols from ambulatory COVID-19 patients infected with the Beta, Delta or Omicron variants', Nature Communications, vol. 15, art. 2003, pp. 1-13. https://DOI.org/10.1038/s41467-024-45400-1.2041-1723 (online)10.1038/s41467-024-45400-1http://hdl.handle.net/2263/101215DATA AVAILABILITY : All data generated and analyzed in this study are included in the paper and its Supplementary section. Individual participant datawill bemade available to researchers who provide a protocol that is approved by their respective human research ethics committee. All protocols will be reviewed and approved by the CAS COVID consortiumtrial steering committee up to five years following publication. A data sharing agreement (DTA) will need to be concluded between the representatives of the requesting institution and the University of Cape Town Lung Institute. Data sharing requests should be directed to keertan. dheda@uct.ac.za. Table S6 provides the accession codes for the WGS of the SARS-CoV-2 variants that could be sequenced for this study. The rawreads and rawcount file for the RNAseq experiment has been deposited on the GEO website under the accession number GSE252508.Airborne transmission of SARS-CoV-2 aerosol remains contentious. Importantly, whether cough or breath-generated bioaerosols can harbor viable and replicating virus remains largely unclarified. We performed size-fractionated aerosol sampling (Andersen cascade impactor) and evaluated viral culturability in human cell lines (infectiousness), viral genetics, and host immunity in ambulatory participants with COVID-19. Sixty-one percent (27/44) and 50% (22/44) of participants emitted variant-specific culture-positive aerosols <10μmand <5μm, respectively, for up to 9 days after symptom onset. Aerosol culturability is significantly associated with lower neutralizing antibody titers, and suppression of transcriptomic pathways related to innate immunity and the humoral response. A nasopharyngeal Ct <17 rules-in ~40% of aerosol culture-positives and identifies those who are probably highly infectious. A parsimonious three transcript blood-based biosignature is highly predictive of infectious aerosol generation (PPV > 95%). There is considerable heterogeneity in potential infectiousness i.e., only 29% of participants were probably highly infectious (produced culture-positive aerosols <5μm at ~6 days after symptom onset). These data, which comprehensively confirm variant-specific culturable SARS-CoV-2 in aerosol, informthe targeting of transmission-related interventions and public health containment strategies emphasizing improved ventilation.en© The Author(s) 2024. Open access. This article is licensed under a Creative Commons Attribution 4.0 International License.CoughTransmissionCOVID-19 pandemicCoronavirus disease 2019 (COVID-19)Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)SDG-03: Good health and well-beingAirborne transmissionArticle