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Edward Nardell

Associate Professor in the Departments of Environmental Health and Immunology and Infectious Diseases

Department of Environmental Health
Department of Immunology and Infectious Diseases

Department of Environmental Health

Department of Immunology and Infectious Diseases

1493 Cambridge St.
Cambridge, Massachusetts 02139

Affiliations

Associate Physician, DSMHI BWH
Associate Professor, Harvard Medical School

Research

Dr Nardell’s research interest in airborne infection and its control began with an outbreak of drug resistant TB in a large homeless shelter in Boston in 1983 when he was the TB Control Officer with the City Health Dept. The outbreak demonstrated that 3 dogmas about TB transmission and pathogenesis were untrue, earning publication in the New England J. of Medicine. Despite latent TB infection being common among the homeless, (1) transmission was occurring, (2) INH resistant TB was transmissible, and (3) exogenous reinfection occurred. In an effort to stop transmission Nardell contacted Richard L. Riley, pioneer researcher of TB transmission and UV air disinfection, beginning an 18 year collaboration during his retirement. Together they wrote and published on UV air disinfection together, and envisioned repeating Riley’s famous Baltimore guinea pig air sampling study to prove its efficacy once and for all under rigorous conditions, and to refine its use. With the 1985-1992 resurgence of drug resistant TB in the US, there was renewed interest in this neglected technology. To deal with low modern ceilings, they circulated a design for tightly louvered fixtures to protect room occupants, the basic design in use today. However, in the era of HIV-related MDR and XDR transmission there is a need to adapt this technology for use in resource-limited settings. Toward that end they have re-established Riley’s experimental apparatus near Pretoria, South Africa and have recently demonstrated that upper room UV can be 80% effective in preventing MDR-TB transmission under rigorous testing. Three years ago, another pioneer, Dr. Melvin First, and Nardell established the first international post-graduate course for engineers, architects, and public health workers on design and engineering strategies to prevent airborne infection.

Education

B.S., 1968, King’s College, Wilkes-Barre, PA
M.D., 1972, Hahnemann University (now Drexel), Philadelphia, PA

Honors and Awards

1992-1994, President, Massachusetts Thoracic Society
1997-1999, President, International Union Against Tuberculosis and Lung Disease (IUATLD), North American Region
1991-1998, Editorial Board – American Journal of Respiratory and Critical Care Medicine
2006, Recipient, Chadwick Medal, Massachusetts Thoracic Society

Publications

1. Patterson WB, Craven DE, Schwartz DA, Nardell EA, Kasmer J, Noble J.  Occupational hazards to hospital personnel.  Ann Intern Med 1985;  102:658-80.

2. Nardell E, McInnis B, Thomas B, Weidhaas S. Exogenous reinfection with tuberculosis in a shelter for the homeless. New Engl J Med 1986; 315:1570-5.

3. Riley RL, Nardell EA. Clearing the air – the theory and application of ultraviolet air disinfection. Am Rev Resp Dis 1989; 139:1286-94.

4. Nardell EA.  Tuberculosis in homeless, residential care facilities, prisons, nursing homes, and other close communities.  Semin Respir Infect 1989;  4:206-15.

5. Nardell EA.  Dodging droplet nuclei. Reducing the probability of nosocomial tuberculosis transmission in the AIDS era.  Am Rev Respir Dis 1990;  142:501-3.

6. Nardell EA, Keegan J, Cheney SA, Etkind SC. Airborne Infection: the theoretical limits of protection achievable by building ventilation. Am Rev Resp Dis 1991; 144:302-6.

7. Fennelly K, Nardell E. The relative efficacy of respirators and room ventilation in preventing occupational tuberculosis. Infection Control Hosp Epidemiol 1998; 10:754-9.

8. Ko G, Burge HA, Nardell EA, Thompson KM. Estimation of tuberculosis risk and incidence under upper room ultraviolet germicidal irradiation in a waiting room in a hypothetical scenario. Risk Anal 2001; 21(4):657-73.

9. Brickner PW, Vincent RL, First M, Nardell E, Murray M, Kaufman W.  The application of ultraviolet germicidal irradiation to control transmission of airborne disease: bioterrorism countermeasure. Public Health Rep 2003;118(2):99-114.

10. Nardell EA. Environmental infection control of tuberculosis.  Semin Respir Infect 2003;  18:307-19.

11. Ko G, Thompson KM, Nardell EA. Estimation of tuberculosis risk on a commercial airliner. Risk Anal 2004; 24(2):379-88.

12. Edwards DA, Man JC, Brand P, Katstra JP, Sommerer K, Stone HA, Nardell E, Scheuch G.  Inhaling to mitigate exhaled bioaerosols.  Proc Natl Acad Sci U S A 2004;101(50):17383-8.

13. First MW, Weker RA, Yasui S, Nardell EA.  Monitoring human exposures to upper-room germicidal ultraviolet irradiation.  J Occup Environ Hyg. 2005 May 2 (5): 285-92.

14. Hohmuth BA, Yamanija JC, Dayal AS, Nardell E, Salazar JJ, Smith Fawzi MC.  Latent tuberculosis infection: risks to health care students at a hospital in Lima, Peru.  Int J Tuberc Lung Dis 2006;  10:1146-51.

15. Friedland G, Churchyard GJ, Nardell E.  Tuberculosis and HIV coinfection: current state of knowledge and research priorities.  J Infect Dis 2007;  196 Suppl 1:S1-3.

16. Bock NN, Jensen PA, Miller B, Nardell E.  Tuberculosis infection control in resource-limited settings in the era of expanding HIV care and treatment.  J Infect Dis 2007;  196 Suppl 1:S108-13.

17. Safety of upper-room ultraviolet germicidal air disinfection for room occupants: results from the Tuberculosis Ultraviolet Shelter Study. Nardell EA, Bucher SJ, Brickner PW, Wang C, Vincent RL, Becan-McBride K, James MA, Michael M, Wright JD. Public Health Rep. 2008 Jan-Feb;123(1):52-60.

18. Dharmadhikari AS, Nardell EA.  What animal models teach humans about tuberculosis.  Am J Respir Cell Mol Biol 2008;  39:503-8.

19. Radonovich LJ, Martinello RA, Hodgson M, Milton DK, Nardell EA.  Influenza and ultraviolet germicidal irradiation.  Virol J 2008;  5:149

20. Javaheri S, Nardell EA, Kazemi H. Role of PCO2 as determinant of CSF (HCO3) in metabolic acidosis. Resp Physiol 1979; 36:155-66.

21. Javaheri S, Nardell EA. Severe metabolic alkalosis. Br Med J 1981; 283:1016-7.

22. Nardell EA, Brody JS. Determinants of the mechanical properties of rat lung during postnatal development. J Appl Physiol 1981; 53(1):140-8.

23. Singleton L, Turner M, Haskal R, Etkind S, Tricarico M, Nardell E. Long-term hospitalization for tuberculosis control. Experience with a medical-psychosocial inpatient unit. JAMA 1997:278(10): 838-42.

24.  Subramanyan GS,Yokoe DS, Sharnprapai S, Nardell E, McCray E, Platt R. Using automated pharmacy records to assess the management of tuberculosis. Emerg Infect Dis 1999;5(6):788-91.

25. Yokoe DS, Subramanyan GS, Nardell E, Sharnprapai S, McCray E, Platt R. Supplementing tuberculosis surveillance with automated data from health maintenance organizations. Emerg Infect Dis 1999;5(6):779-87.

26. Sharprappai S, Miller AC, Suruki R, Corkren E, Etkind S, Driscoll J, McGerry M, Nardell E. Genotyping analysis of tuberculosis Cases in the U.S.- and foreign-born Massachusetts residents. Emerg Infect Dis [serial online] 2002:8. Available from: URL: http://www.cdc.gov/ncidod/EID/vol8no11/02-0370.htm

27. Northrup JM, Miller AC, Nardell E, Sharnprapai S, Etkind S, Driscoll J, et al. Estimated costs of false laboratory diagnoses of tuberculosis in three patients. Emerg Infect Dis [serial online] 2002;8. Available from: URL: http://www.cdc.gov/ncidod/EID/vol8no11/02-0387.htm

28. Szot A, Jacobson F, Munn S, Jazayeri D, Nardell E, Harrison D, Drosten R, Ohno-Machado L, Smeaton LM, Fraser HSF. Diagnostic accuracy of chest X-rays acquired using a digital camera for low-cost teleradiology. Int. J. Med. Inform., 2004; 73(1): 65-73.

29. Timperi R, Han LL, Sloutsky A, Becerra MC, Nardell EA, Salazar JJ, Smith-Fawzi MC.  Drug resistance profiles of Mycobacterium tuberculosis isolates: five years’ experience and insight into treatment strategies for MDR-TB in Lima, Peru. Int J Tuberc Lung Dis 2005; 9:175-80.

30. Representative drug susceptibility patterns for guiding design of retreatment regimens for MDR-TB. Rich ML, Socci AR, Mitnick CD, Nardell EA, Becerra MC, Bonilla C, Bayona J, Seung KJ, Furin J, Farmer PE, Mukherjee JS. Int J Tuberc Lung Dis. 2006 Mar;10(3):290-6.

31. Nardell EA, Wallis RS.  Here today–gone tomorrow: the case for transient acute tuberculosis infection.  Am J Respir Crit Care Med 2006;  174:734-5.

32. Nardell EA, Mitnick CD.  Are second-line drugs necessary to control multidrug-resistant tuberculosis?  J Infect Dis 2006;  194:1194-6.

33. Discordant QuantiFERON-TB Gold test results among US healthcare workers with increased risk of latent tuberculosis infection: a problem or solution? Pollock NR, Campos-Neto A, Kashino S, Napolitano D, Behar SM, Shin D, Sloutsky A, Joshi S, Guillet J, Wong M, Nardell E.  Infect Control Hosp Epidemiol. 2008 Sep;29(9):878-86.

34. Keshavjee S, Gelmanova IY, Farmer PE, Mishustin SP, Strelis AK, Andreev YG, et al.   Treatment of extensively drug-resistant tuberculosis in Tomsk, Russia: a retrospective cohort study.  Lancet 2008;  372:1403-9.

35. Keshavjee S, Gelmanova IY, Pasechnikov AD, Mishustin SP, Andreev YG, Yedilbayev A, et al.   Treating multidrug-resistant tuberculosis in Tomsk, Russia: developing programs that address the linkage between poverty and disease.  Ann N Y Acad Sci 2008;  1136:1-11.

36. Pollock NR, Kashino SS, Napolitano DR, Sloutsky A, Joshi S, Guillet J, et al.   Evaluation of the effect of treatment of latent tuberculosis infection on QuantiFERON-TB gold assay results.  Infect Control Hosp Epidemiol 2009;  30:392-5.