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In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2

Educational Objective
To understand the in vitro efficacy of a povidone-iodine nasal antiseptic for rapid inactivation of SARS-CoV-2
1 Credit CME
Key Points

Question  What is the minimum contact time of povidone-iodine (PVP-I) nasal antiseptic required for inactivation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro?

Findings  In this controlled in vitro laboratory research study, test media infected with SARS-CoV-2 demonstrated complete inactivation of SARS-CoV-2 by concentrations of PVP-I nasal antiseptic as low as 0.5% after 15 seconds of contact, as measured by a log reduction value of greater than 3 log10 of the 50% cell culture infectious dose of the virus.

Meaning  Intranasal PVP-I rapidly inactivates SARS-CoV-2 and may play an adjunctive role in mitigating viral transmission beyond personal protective equipment.


Importance  Research is needed to demonstrate the efficacy of nasal povidone-iodine (PVP-I) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Objective  To evaluate the in vitro efficacy of PVP-I nasal antiseptic for the inactivation of SARS-CoV-2 at clinically significant contact times of 15 and 30 seconds.

Interventions  The SARS-CoV-2, USA-WA1/2020 strain, virus stock was tested against nasal antiseptic solutions consisting of aqueous PVP-I as the sole active ingredient. Povidone-iodine was tested at diluted concentrations of 0.5%, 1.25%, and 2.5% and compared with controls. The test solutions and virus were incubated at mean (SD) room temperature of 22 (2) °C for time periods of 15 and 30 seconds.

Design and Setting  This controlled in vitro laboratory research study used 3 different concentrations of study solution and ethanol, 70%, as a positive control on test media infected with SARS-CoV-2. Test media without virus were added to 2 tubes of the compounds to serve as toxicity and neutralization controls. Ethanol, 70%, was tested in parallel as a positive control and water only as a negative control.

Main Outcomes and Measures  The primary study outcome measurement was the log reduction value after 15 seconds and 30 seconds of given treatment. Surviving virus from each sample was quantified by standard end point dilution assay, and the log reduction value of each compound was compared with the negative (water) control.

Results  Povidone-iodine nasal antiseptics at concentrations (0.5%, 1.25%, and 2.5%) completely inactivated SARS-CoV-2 within 15 seconds of contact as measured by log reduction value of greater than 3 log10 of the 50% cell culture infectious dose of the virus. The ethanol, 70%, positive control did not completely inactivate SARS-CoV-2 after 15 seconds of contact. The nasal antiseptics tested performed better than the standard positive control routinely used for in vitro assessment of anti–SARS-CoV-2 agents at a contact time of 15 seconds. No cytotoxic effects on cells were observed after contact with each of the nasal antiseptics tested.

Conclusions and Relevance  Povidone-iodine nasal antiseptic solutions at concentrations as low as 0.5% rapidly inactivate SARS-CoV-2 at contact times as short as 15 seconds. Intranasal use of PVP-I has demonstrated safety at concentrations of 1.25% and below and may play an adjunctive role in mitigating viral transmission beyond personal protective equipment.

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Article Information

Accepted for Publication: July 29, 2020.

Corresponding Author: Samantha Frank, MD, Division of Otolaryngology−Head and Neck Surgery, Department of Surgery, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030 (sfrank@uchc.edu).

Published Online: September 17, 2020. doi:10.1001/jamaoto.2020.3053

Author Contributions: Drs Frank, Capriotti, and Tessema had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Frank, Capriotti, Westover, Tessema.

Drafting of the manuscript: Frank, Capriotti, Pelletier, Tessema.

Critical revision of the manuscript for important intellectual content: Frank, Brown, Capriotti, Westover, Tessema.

Statistical analysis: Capriotti, Westover.

Obtained funding: Capriotti.

Administrative, technical, or material support: Brown, Capriotti, Westover, Tessema.

Supervision: Brown, Capriotti, Westover, Pelletier, Tessema.

Conflict of Interest Disclosures: Dr Brown reported personal financial investment in Halodine outside the submitted work. Dr Capriotti is the executive director of Veloce BioPharma and reported a patent to multiple related drugs issued and licensed by Veloce BioPharma. Dr Pelletier is a consultant for Veloce BioPharma and reported equity in both Veloce BioPharma and Halodine. Dr Tessema reported personal financial investment in Halodine outside the submitted work, and has a patent to multiple drug products pending. No other disclosures were reported.

Funding/Support: The funding for the laboratory materials used in this study was supplied by Veloce BioPharma.

Role of the Funder/Sponsor: Veloce BioPharma had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. However, the individual authors listed who are related to Veloce BioPharma did assist with design of the study and review of the manuscript.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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