Abstract
BackgroundTransporting over two billion passengers per year, global airline travel has the potential to spread emerging infectious diseases, both via transportation of infectious cases and through in-flight transmission. Current World Health Organization (WHO) guidance recommends contact tracing of passengers seated within two rows of a case of influenza during air travel.ObjectivesThe objectives of this study were to describe flight-related transmission of influenza A(H1N1)pdm09 during a commercial flight carrying the first cases reported in the United Kingdom and to test the specific hypothesis that passengers seated within two rows of an infectious case are at greater risk of infection.MethodsAn historical cohort study, supplemented by contact tracing, enhanced surveillance data and laboratory testing, was used to establish a case status for passengers on board the flight.ResultsData were available for 239 of 278 (86·0%) of passengers on the flight, of whom six were considered infectious in-flight and one immune. The attack rate (AR) was 10 of 232 (4·3%; 95% CI 1·7–6·9%). There was no evidence that the AR for those seated within two rows of an infectious case was different from those who were not (relative risk 0·9; 95% CI 0·2–3·1; P = 1·00). Laboratory testing using PCR and/or serology, available for 118 of 239 (49·4%) of the passengers, was largely consistent with clinically defined case status.ConclusionsThis study of A(H1N1)pdm09 does not support current WHO guidance regarding the contact tracing of passengers seated within two rows of an infectious case of influenza during air travel.
Highlights
An emergent novel swine-origin influenza A(H1N1)pdm[09] virus was first identified in humans on 15th April 2009; on 25th April 2009, the World Health Organization declared the outbreak a ‘public health emergency of international concern’.1 The subsequent influenza pandemic spread from Mexico to at least 214 countries with over 18 000 laboratoryconfirmed deaths worldwide, with the true burden of disease many times greater.[2,3]With over 2 billion passengers per year, global airline travel represents an important vehicle for the spread of emerging infectious diseases such as pandemic influenza, both through the transportation of infected passengers and through the potential for in-flight transmission of disease
Current World Health Organization (WHO) technical advice for case management of influenza infection in-flight includes specific measures to reduce transmission and recommends the completion of passenger locator cards to facilitate subsequent contact tracing of passengers seated within two rows of an infected case.[11]
The data sources used were an historical cohort study using a telephone questionnaire administered following the flight; initial contact tracing of passengers seated within two rows of the first identified case and enhanced surveillance data collected by the Health Protection Agency (HPA) at the time of the pandemic
Summary
An emergent novel swine-origin influenza A(H1N1)pdm[09] virus was first identified in humans on 15th April 2009; on 25th April 2009, the World Health Organization declared the outbreak a ‘public health emergency of international concern’.1 The subsequent influenza pandemic spread from Mexico to at least 214 countries with over 18 000 laboratoryconfirmed deaths worldwide, with the true burden of disease many times greater.[2,3]With over 2 billion passengers per year, global airline travel represents an important vehicle for the spread of emerging infectious diseases such as pandemic influenza, both through the transportation of infected passengers and through the potential for in-flight transmission of disease. Previous studies have described the spread of influenza during air travel,[4,5] including five reports of transmission of influenza A(H1N1)pdm[09] on commercial flights.[6,7,8,9,10] Current World Health Organization (WHO) technical advice for case management of influenza infection in-flight includes specific measures to reduce transmission and recommends the completion of passenger locator cards to facilitate subsequent contact tracing of passengers seated within two rows of an infected case.[11]. Current World Health Organization (WHO) guidance recommends contact tracing of passengers seated within two rows of a case of influenza during air travel
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