Abstract
A small proportion of air travelers make disproportionately more journeys than the rest of travelers. They also tend to interact predominantly with other frequent travelers in hotels and airport lounges. This group has the potential to accelerate global spread of infectious respiratory diseases. Using an epidemiologic model, we simulated exportation of cases from severe acute respiratory syndrome-like and influenza-like epidemics in a population for which a small proportion travel more frequently than the rest. Our simulations show that frequent travelers accelerate international spread of epidemics only if they are infected early in an outbreak and the outbreak does not expand rapidly. If the epidemic growth rate is high, as is likely for pandemic influenza, heterogeneities in travel are frequently overwhelmed by the large number of infected persons in the majority population and the resulting high probability that some of these persons will take an international flight.
Highlights
A small proportion of air travelers make disproportionately more journeys than the rest of travelers
As an epidemic progresses, the cumulative number of cases increases, and the number of asymptomatic cases exported from a source area increases for all travel patterns (Figure 2)
If the epidemic is initiated in the low-frequency fliers, the mean number of exported cases is similar to results of the homogeneous model (Figure 2, panel A, closed symbols)
Summary
A small proportion of air travelers make disproportionately more journeys than the rest of travelers They tend to interact predominantly with other frequent travelers in hotels and airport lounges. In today’s world of increasing air travel for both business and pleasure, a small proportion of persons make disproportionately more journeys than the rest of the population [1,2] These frequent fliers tend to travel for business purposes and mix predominantly with other business travelers, stay in particular hotels, and use specific airport lounges. This form of assortative (like with like) mixing means a respiratory infection could potentially spread quickly within this group and be disseminated rapidly between countries. Of interest is whether targeting interventions at frequent travelers would slow the international spread of a defined pathogen
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