Influenza can be transmitted through the air by larger respiratory droplets and smaller aerosolized particles. It may also be spread through contact with contaminated surfaces. There are many ways to prevent getting sick with the flu.

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Influenza viruses cause a respiratory illness that you may know more commonly as “the flu.” In the United States, the Centers for Disease Control and Prevention (CDC) estimates that there were 35 to 65 million flu illnesses during the 2023 to 2024 flu season.

The flu is contagious, meaning that it can spread from person to person. But how is it spread? Is it airborne, or is it spread by other means, such as by droplets or contact? Keep reading below as we explore what to know about how influenza spreads.

So how exactly is influenza spread? Is it airborne, spread by droplets, or through contact? Why not all three?

Let’s explore what we know about each type of transmission.

Respiratory droplets

According to the CDC, most experts believe that influenza viruses are mainly spread by respiratory droplets.

Respiratory droplets are made when you sneeze, cough, or talk. If respiratory droplets containing influenza virus come into contact with your mucus membranes, such as those in your nose or mouth, you can get sick.

Research suggests that respiratory droplets are on the larger side, typically greater than 5 micrometers (µm) in size. Due to this, they don’t get very far and typically travel less than 6 feet before they fall out of the air the CDC reports.

That means you have to be pretty close to someone to contract the virus from them. However, respiratory droplets can fall onto various objects and surfaces, which leads us to our next method.

Contact

When respiratory droplets fall out of the air, they can land on nearby surfaces. Depending on the conditions, influenza virus can still be infectious for many hours.

For example, the virus can survive on hard, non-porous surfaces for 24 to 48 hours.

You can contract the virus if you touch a contaminated surface and then touch your nose or mouth.

Airborne transmission

When we talk about airborne transmission, we’re generally referring to aerosolized particles containing influenza virus that are less than 5 µm in size. These types of particles can be made simply by breathing.

Unlike respiratory droplets (made when coughing or sneezing), which tend to land in the nose and throat, airborne particles can travel deeper into your respiratory tract. Because they are smaller, they can also remain suspended in the air for longer.

The CDC notes that airborne transmission of influenza virus can occur when you’re in the vicinity of someone with the virus.

Indeed, a 2020 study notes that previous research has found that 42% to 63% of particles containing influenza virus are of this small, respirable size.

Further, researchers conducting a small 2018 study involving people with confirmed influenza and symptomatic were able to recover infectious virus from fine aerosols collected from breathing samples.

Overall, the exact contribution of the airborne route of influenza transmission remains unclear. While an older 2013 study estimated that the airborne route may account for half of all influenza transmission events, more research is needed.

Yes. Improving ventilation indoors, such as through air filtration, can help prevent the spread of respiratory viruses like influenza.

The Environmental Protection Agency (EPA) notes that to be effective at removing viruses from the air, an air cleaner must be able to remove very small airborne particles, which it defines as those between 0.1 to 1 µm in size.

They recommend checking the product information provided by the manufacturer to verify that an air cleaner can remove particles of this size.

While air filtration can lower levels of virus in the air, it isn’t a substitute for other preventive measures, such as avoiding contact with people who are sick, handwashing frequently, and cleaning high-touch surfaces.

The amount of time that influenza stays in the air can depend on the size of the particles that it’s in.

For example, respiratory droplets between the sizes of 5 and 100 µm can remain in the air for about 5 minutes before dropping onto nearby surfaces.

Aerosolized, or airborne, particles can stay in the air for longer. This is particularly true if there’s poor airflow or ventilation.

One 2015 study involved aerosolizing a laboratory strain of influenza and sampling the air. It found that after 60 to 90 minutes, levels of infectious virus in the air were still enough to cause an infection.

Aside from particle size, there are several other factors that can affect how long the influenza virus is infectious in the air or on surfaces. These include:

  • Temperature: The influenza virus is more stable at lower temperatures.
  • Humidity: Influenza virus is generally more likely to spread at lower humidity levels.
  • UV radiation: Exposure to UV radiation, such as from sunlight, can inactivate influenza viruses.

Does winter weather cause influenza?

Yes and no. While the season doesn’t directly cause an influenza infection, some winter climates can cause the influenza virus to spread more easily.

In many places the winter climate is colder and dryer, which can help the virus survive longer in the air and on surfaces. In addition, you’re more likely to spend time in crowded indoor spaces with poor ventilation and less likely to be using sunscreen (although it’s still important to).

This can create an ideal situation for influenza to spread across communities during the winter months.

According to the CDC, wearing a mask is an additional method for preventing the spread of respiratory viruses like influenza.

The protection goes both ways and can protect you and your community. If you currently have the flu, wearing a mask can help lower your risk of passing it to others. If you don’t have the flu, a mask can prevent you from breathing in particles containing the virus.

A 2020 analysis of 21 studies found that masks had a protective effect against respiratory viruses, including influenza.

The authors of the analysis do point out that other studies have found that masks didn’t have a significant effect on influenza transmission. However, these studies often did not account for mask type, fit, or whether they were used consistently and properly.

If you choose to wear a mask to prevent the flu, wearing a mask that offers a higher level of protection, such as a KN95, and fits well can help ensure that you receive the most benefits.

Yes. Hand hygiene, including using hand sanitizer, can significantly protect against influenza. Hand sanitizer can be particularly beneficial when soap and water are not readily available.

For example, one small 2019 study found that, compared to schools with no hand hygiene methods, those using hand sanitizer had a 53% lower incidence of laboratory-confirmed influenza infections.

However, it’s important to note that some research suggests hand sanitizer is less effective than handwashing when the influenza virus is found in mucus.

These results align with the CDC guidance that handwashing with soap and water is the best way to remove germs from your hands.

Hand sanitizer can be used if soap and water are not available. Just be sure to use one that contains at least 60% alcohol, according to the CDC.

Influenza virus can spread in many different ways.

It can be transmitted through the air via respiratory droplets and airborne transmission. You can also contract the flu virus from contacting contaminated surfaces and then touching your nose or mouth.

There are many ways to prevent the flu. Some of these prevention methods we’ve discussed in detail here include practicing good hand hygiene, using an air filtration system, or wearing a mask.

Another great way to prevent contracting the flu virus is getting the seasonal flu vaccine. Receiving the flu vaccine each year can help prevent sickness and complications from the flu. If you do get sick, it can help reduce the length and severity of your illness.