How Germs Are Transmitted

Knowing how germs spread is a key factor in preventing disease, and it varies for different bacteria, viruses, and other pathogens. In some cases, you have to come into direct contact with an infected person to be infected. In others, the germ may be aerosolized (for instance, when someone sneezes) and find its way into your body when you simply take a breath. Some diseases can be spread in more than one way.

By understanding these and other modes of germ transmission, you can protect your health and that of the people around you.

This article discusses the different ways diseases are transmitted. It also looks at some of the precautions you can take to prevent transmitting or contracting certain diseases.

Droplet Transmission

Droplet transmission occurs when droplets containing a virus leave a person's body when they cough, sneeze, or speak. The droplets might enter the eyes, nose, or mouth of someone nearby. Generally, droplets are not in the air for a long time, but they can be breathed in; germs can also be transmitted when someone comes into contact with a surface droplets have landed on.

Some examples of diseases spread through droplet transmission include:

• The common cold
• Influenza (flu)
• Pertussis (whooping cough)
  

Respiratory droplets can be spread as far as 6 feet away from their source.

Cold and flu viruses can remain infective on surfaces for hours and up to a few days. If someone touches the surface and then touches their mouth, nose, or eyes, they may become infected.

Droplet Transmission Precautions

To prevent or reduce droplet transmission, cough or sneeze into a tissue or your elbow. Then, wash your hands so you don't pass your germs on. Likewise, to protect yourself from germs you may pick up, wash your hands frequently, use hand sanitizer when you don't have soap and water available, and try not to touch your face.

Airborne Transmission

In airborne transmission, a virus or bacteria remains in the air for a long period of time, can be distributed by airflow, and can be inhaled. For this to occur, the size of the droplet nuclei that remains and is aerosolized after the droplet is dried out must be very small, and the germ must be able to survive being dried out.

Germs capable of airborne transmission can reach the lower respiratory tract when inhaled. It may not take many germs for an infection to occur.

Fortunately, only a few germs are commonly spread by airborne transmission. These include:

There is scientific debate as to whether influenza can be airborne, although most agree that droplet transmission is the usual route.

When there is an outbreak of a novel pathogen, such as the coronavirus diseases COVID-19 and Middle East respiratory syndrome (MERS), researchers look closely at transmission patterns to see if it can be airborne, as this has many implications for controlling its spread.

Airborne Transmission Precautions

It is much more difficult to prevent transmitting or catching airborne infections. Isolating those who are sick is an important way to control the spread.

In a medical setting, negative pressure isolation rooms ensure that air is drawn into the room from the outside, so it is not recirculated to/from other patients. The use of N95 respirators rather than surgical masks is needed to protect healthcare personnel from airborne diseases.

N95 respirators are expensive and must be properly fitted, and users must be trained to use them. For this reason, it is important to know when they are truly needed. In the case of influenza (where there is debate about airborne spread), studies have shown that wearing surgical masks is as effective for protecting healthcare personnel as N95 respirators.

Vaccination can prevent the spread of chickenpox and measles, but vaccines for tuberculosis are not used in the U.S.

Direct Contact Transmission

Close physical contact is required to transmit some diseases, as these germs can't survive for any time away from a host (the body). They are spread via saliva, wound secretions, sexual contact, etc. Sexually-transmitted diseases are in this category. For other germs, this can be an additional mode of transmission (e.g., passing a cold via kissing).

Direct Contact Precautions

In daily life, safer sex practices are steps that can be taken to prevent direct contact transmission. In healthcare settings, standard precautions including wearing gloves, masks, and washing hands can prevent direct transmission.

Bloodborne Transmission

Some diseases spread through contact with blood. Examples include:

Bloodborne transmission is a type of direct contact transmission. It can occur when someone's blood enters an open wound or mucous membrane. It can also happen through shared personal objects that contain trace amounts of blood, such as hypodermic needles.

Bloodborne Transmission Precautions

Avoid sharing items that have been in contact with someone else's blood, such as a razor or hypodermic needle. In a healthcare setting, providers should wear gloves and additional equipment such as a mask, gown, and eyewear if there's a possibility of blood splash.

Indirect Contact Transmission

Some germs can live a shorter or longer time on a contaminated surface. They may be spread to surfaces via droplets or transfer of mucus, blood, saliva, feces, or wound secretions. The objects that harbor these germs are called fomites.

Surfaces that are touched frequently by different people carry the greatest risk, such as door handles, tables, restroom surfaces, eating and drinking utensils, writing utensils, shared electronic devices, and so on. Sharing personal items such as razors, utensils, and needles also raises the risk that they may be contaminated.

Indirect Contact Precautions

Indirect contact transmission can be prevented by handwashing after using the restroom, before and after preparing food and eating, and after touching any shared surfaces, as well as not touching your face. Disinfecting these surfaces may also help.

Norovirus is a classic example of a virus spread by indirect contact. It can survive for days on surfaces.  

Fecal-Oral Transmission

Contaminated food and water are the modes of transmission of many bacteria and viruses that infect the digestive system and are shed in the feces. Some examples of diseases spread this way include:

• Many kinds of stomach flu
• Salmonella
• E. coli

Waterborne illness may result from ingesting, bathing, or swimming in contaminated water. While municipal water supplies in developed countries are rarely a risk, you might be exposed when traveling, in times of disaster, or when swimming in a river, stream, or pond.

Fecal-Oral Transmission Precautions

Foodborne illness is often due to improper hygiene. Failure to wash your hands thoroughly after using the restroom can transfer germs to food you are preparing or serving.

As well, improper hygiene can transfer fecal bacteria and viruses to surfaces, where others can pick them up and transfer them to the mouth (hence, the name fecal-oral route).

Vector-Borne Transmission

Vector-borne diseases are transmitted from human to human or from an animal to a human through an arthropod such as a mosquito or tick. In these cases, the germ must pass through the vector host before it can infect humans, such as with malaria.

Examples of vector-borne illnesses include:

• Malaria
• Zika
• West Nile
• Plague
• Lyme disease
• Rocky Mountain spotted fever

Vector-Borne Precautions

In cases like malaria, it may be possible to control the spread by eliminating the mosquito vector. In others, including tick-borne Lyme disease and Rocky Mountain spotted fever, it is best to avoid the vector.

What Is the Difference Between a Vector-Borne Disease and a Zoonotic Disease?

A zoonotic disease is a disease that can be passed from an animal to a human in various ways such as droplet transmission or through a bite or scratch. Some examples of zoonotic diseases include:

• Avian influenza (bird flu)
• Hantavirus pulmonary syndrome (HPS)
• Rat bite fever
• Leptospirosis
• Rabies

Vaccination of dogs and cats can prevent the spread of rabies.

Summary

Diseases can spread through various modes of transmission, including droplets, direct contact, and indirect contact. Pathogens can also become airborne, and some can spread through the fecal-oral route.

Many types of transmission can be prevented by good health and hygiene practices. When you are sick, stay away from others, especially those most at risk of complications if they become ill. Clean the surfaces you touch as much as possible, and be diligent about handwashing.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Centers for Disease Control and Prevention. Influenza (flu): How flu spreads.
2. Marquès M, Domingo JL. Contamination of inert surfaces by SARS-CoV-2: Persistence, stability and infectivity. A review. Environ Res. 2021;193:110559. doi:10.1016/j.envres.2020.110559
3. Tellier R, Li Y, Cowling BJ, Tang JW. Recognition of aerosol transmission of infectious agents: a commentary. BMC Infect Dis. 2019;19(1):101. doi:10.1186/s12879-019-3707-y
4. Seto WH. Airborne transmission and precautions: facts and myths. J Hosp Infect. 2015;89(4):225-8. doi:10.1016/j.jhin.2014.11.005
5. ARadonovich LJ Jr, Simberkoff MS, Bessesen MT, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: A randomized clinical trial. JAMA. 2019;322(9):824–833. doi:10.1001/jama.2019.11645
6. Centers for Disease Control and Prevention. Section 10: Chain of infection.
7. Centers for Disease Control and Prevention. Norovirus illness: Key facts.

By Kristina Herndon, RN
Kristina Herndon, BSN, RN, CPN, has been working in healthcare since 2002. She specializes in pediatrics and disease and infection prevention.

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