RESUMEN
Aim: To prevent COVID-19 all preventive hygiene measures possible must be taken for the protection of, in particular, medical personnel but also the general population, because even if a vaccine is available its protective effect will not be known. A literature search was conducted to analyse whether virucidal mucosal antisepsis is an adequate measure for the prevention of COVID-19. In addition, the role of mouthwash/gargling was analysed as an unspecific measure for the prevention of respiratory infections. The methodology was designed to present in vitro results and study findings as a synopsis. Results: As from a concentration of 0.45%, povidone (PVP) iodine inactivates in vitro enveloped viruses, including SARS-CoV-2. One Japanese PVP iodine gargle/mouthwash formulation was effective even in a concentration of 0.23% against SARS-CoV-1, MERS-CoV and influenza virus H1N1. Above 42.6%, ethanol is effective against SARS-CoV-1, MERS-CoV, influenza A and B viruses. In combination with etheric oils, 21.6% ethanol sufficed to inactivate influenza virus and SARS-CoV-2. 0.2% sodium hypochlorite is effective against coronaviruses. Chlorhexidine digluconate (0.12%) is in vitro > 2 lg less effective against SARS-CoV-2 as 1% PVP iodine. 0.1% octenidine dihydrochloride is in vitro as effective against SARS-CoV-2 as chlorhexidine. Replication of coronaviruses is completely suppressed through the induction of interferons when the active substance is brought into contact with cell cultures before infection. 1.5% hydrogen peroxide does not reach the effectiveness of chlorhexidine. Hypertonic saline solution (3%, 2.5% and 2%) inhibits virus replication in rhino- as well as coronaviruses. Sage extract is effective against vesicular stomatitis virus, avian infectious bronchitis and herpes simplex virus. Combined rhubarb and sage cream was as effective against labial herpes (cold sores) as acyclovir. Hence, efficacy against coronaviruses is assumed. PVP iodine is considered to be the active ingredient of choice when used for pre- and post-exposure prophylaxis based on the state of knowledge on virucidal efficacy and mucosal tolerance based on the scientific insights gained over decades. If contraindicated by the patient’s history, (hyperthyroidism, autonomic adenoma, allergy), alternative, albeit less-well studied, substances should be considered. In aerosol-generating medical procedures, e.g. before bronchoscopy, intubation and dental treatment, irrigation of the patient’s oral cavity with 1% or 1.25% aqueous PVP iodine solution, if possible in combination with gargling, is recommended as pre-exposure prophylaxis, while prior to ear, nose and throat (ENT) diagnostic interventions/procedures its application as a spray into the nasal vestibule is recommended. After accidental exposure of the eyes and nasal cavity, 1.25 aqueous PVP iodine solution can be used as postexposure prophylaxis. It must be ensured that ophthalmic agents are sterile. So long as there are regional/local clusters of SARS-CoV-2 infections, gargling in the morning and evening with 0.23% aqueous PVP iodine solution and its application as a nasal spray are likely to provide additional protection to healthcare workers. In Japan gargling with 0.23% aqueous PVP iodine solution is recommended for the entire population. In April 2020, the WHO has included a PVP-I gargle solution in its list of experimental treatments for COVID-19. As seen at the beginning of the epidemic spread of influenza in the population, daily gargling with e.g. 0.23% aqueous PVP iodine solution, in combination with ethanol/etheric oils or hypertonic saline solution, is recommended. Just as with the advent of the COVID-19 pandemic the wearing of face masks/face coverings has assumed a new role in the general population, so too will the Japanese tradition of antiseptic gargling perhaps experience a resurgence in Europe. Conclusion: Clinical and epidemiological studies are indispensable to corroborate the in vitro findings and inferred recommendations. © 2020 mhp-Verlag GmbH. All rights reserved.
RESUMEN
In the ongoing SARS CoV-2 pandemic, effective disinfection measures are needed, and guidance based on the methodological framework of the European Committee for Standardization (CEN) may enable the choice of effective disinfectants on an immediate basis. This study aimed to elucidate whether disinfectants claiming 'virucidal activity against enveloped viruses' as specified in the European Standard EN 14476 as well as in the German Association for the Control of Viral Diseases/Robert Koch Institute (DVV/RKI) guideline are effectively inactivating SARS-CoV-2. Two commercially available formulations for surface disinfection and one formulation for hand disinfection were studied regarding their virucidal activity. Based on the data of this study the enveloped SARS-CoV-2 is at least equally susceptible compared to the standard test virus vaccinia used in the EN 14476 and DVV/RKI guidelines. Thus, chemical disinfectants claiming 'virucidal activity against enveloped viruses' based on the EN 14476 and DVV/RKI guidelines will be an effective choice to target enveloped SARS-CoV-2 as a preventive measure.