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Infectious Risks of Air Travel

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  • Authors: Alexandra Mangili1, Tine Vindenes2, Mark Gendreau3
  • Editor: David Schlossberg4
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Department of Infectious Disease, Tufts University, Boston, MA 02111; 2: Tufts Medical Center, Boston, MA 02111; 3: Lahey Clinic, Burlington, MA 01805; 4: Philadelphia Health Department, Philadelphia, PA
  • Source: microbiolspec October 2015 vol. 3 no. 5 doi:10.1128/microbiolspec.IOL5-0009-2015
  • Received 27 February 2015 Accepted 25 March 2015 Published 09 October 2015
  • Alexandra Mangili, alexandra.mangili@tufts.edu
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  • Abstract:

    Infectious diseases are still among the leading causes of death worldwide due to their persistence, emergence, and reemergence. As the recent Ebola virus disease and MERS-CoV outbreaks demonstrate, the modern epidemics and large-scale infectious outbreaks emerge and spread quickly. Air transportation is a major vehicle for the rapid spread and dissemination of communicable diseases, and there have been a number of reported outbreaks of serious airborne diseases aboard commercial flights including tuberculosis, severe acute respiratory syndrome, influenza, smallpox, and measles, to name a few. In 2014 alone, over 3.3 billion passengers (a number equivalent to 42% of the world population) and 50 million metric tons of cargo traveled by air from 41,000 airports and 50,000 routes worldwide, and significant growth is anticipated, with passenger numbers expected to reach 5.9 billion by 2030. Given the increasing numbers of travelers, the risk of infectious disease transmission during air travel is a significant concern, and this chapter focuses on the current knowledge about transmission of infectious diseases in the context of both transmissions within the aircraft passenger cabin and commercial aircraft serving as vehicles of worldwide infection spread.

  • Citation: Mangili A, Vindenes T, Gendreau M. 2015. Infectious Risks of Air Travel. Microbiol Spectrum 3(5):IOL5-0009-2015. doi:10.1128/microbiolspec.IOL5-0009-2015.

Key Concept Ranking

Severe Acute Respiratory Syndrome
0.48731232
Infectious Diseases
0.40741727
0.48731232

References

1. Air Transport Action Group. www.atag.org.
2. ARCP. 2013. Report 91. Infectious Disease Mitigation in Airports and on Aircraft.
3. Bogoch II, Creator MI, Cetron MS, Brownstein JS, et al. 2015. Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 West African outbreak. Lancet 385:29–35. [PubMed][CrossRef]
4. Coburn BJ, Blower S. 2014. Predicting the potential for within-flight transmission and global dissemination of MERS. Lancet Infect Dis 14:99. [PubMed][CrossRef]
5. European Center for Disease Prevention and Control. Risk assessment guidelines of infectious disease transmitted on aircraft. 2009. Stockholm: ECDC.
6. Gardner L, Sarkar S. 2013. A global airport-based risk model for the spread of dengue infection via the air transport network. PloS One 8:e72129. [PubMed][CrossRef]
7. Grais RF, Ellis JH, Glass GE. 2003. Forecasting the geographical spread of smallpox cases by air travel. Epidemiol Infect 131:849–857. [PubMed][CrossRef]
8. Huang Z, Tatem AJ. 2013. Global malaria connectivity through air travel. Malaria 12:269. [PubMed][CrossRef]
9. International Civil Aviation Organization. 2007. Guidelines for States Concerning the Management of Communicable Disease Posing a Serious Public Health Risk. International Civil Aviation Organization, Montreal, Canada.
10. Johansson MA, Arana-Vizcarrondo N, Biggerstaff BJ, Gallagher N, Marano N, Staples JE. 2012. Assessing the risk of international spread of yellow fever virus: a mathematical analysis of an urban outbreak in Asuncion, 2008. Am J Trop Med Hyg 86:349–358. [PubMed][CrossRef]
11. Kantele A, Valtonen K, Davidkin I, Martelius T, Võželevskaja N, Skogberg K, Liesmaa I, Lyytikäinen O. 2012. Travellers returning with measles from Thailand to Finland, April 2012: infection control measures. Euro Surveill 2012:17(22).
12. Khan K, Eckhardt R, Brownstein JS, Naqvi R, Hu W, Kossowsky D, Scales D, Arino J, MacDonald M, Wang J, Sears J, Cetron MS. 2013. Entry and exit screening of airline travellers during the A (H1N1) pandemic: a retrospective evaluation. Bull World Health Organ 91:368–376. [PubMed][CrossRef]
13. Lin C. 2009. Airborne disease risk modeling. M.S. thesis. University of British Columbia, Vancouver, BC, Canada. https://circle.ubc.ca/bitstream/handle/2429/43206/ubc_2012_fall_lin_chu.pdf?sequence=1.
14. Mangili A, Gendreau MA. 2005. Transmission of infectious diseases during commercial air travel. Lancet 365:989–996. [PubMed][CrossRef]
15. World Health Organization. 2008. International Health Regulations (2005), 2nd ed. World Health Organization (CHE), Geneva, Switzerland.
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2015-10-09
2017-03-29

Abstract:

Infectious diseases are still among the leading causes of death worldwide due to their persistence, emergence, and reemergence. As the recent Ebola virus disease and MERS-CoV outbreaks demonstrate, the modern epidemics and large-scale infectious outbreaks emerge and spread quickly. Air transportation is a major vehicle for the rapid spread and dissemination of communicable diseases, and there have been a number of reported outbreaks of serious airborne diseases aboard commercial flights including tuberculosis, severe acute respiratory syndrome, influenza, smallpox, and measles, to name a few. In 2014 alone, over 3.3 billion passengers (a number equivalent to 42% of the world population) and 50 million metric tons of cargo traveled by air from 41,000 airports and 50,000 routes worldwide, and significant growth is anticipated, with passenger numbers expected to reach 5.9 billion by 2030. Given the increasing numbers of travelers, the risk of infectious disease transmission during air travel is a significant concern, and this chapter focuses on the current knowledge about transmission of infectious diseases in the context of both transmissions within the aircraft passenger cabin and commercial aircraft serving as vehicles of worldwide infection spread.

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FIGURE 1

Determinants of risk of infection within a confined space. doi:10.1128/microbiolspec.IOL5-0009-2015.f1

Source: microbiolspec October 2015 vol. 3 no. 5 doi:10.1128/microbiolspec.IOL5-0009-2015
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Image of FIGURE 2
FIGURE 2

Risk-based border screening of airline passengers during a novel-agent pandemic. Risk-based border screening of arriving passengers during a worldwide infectious outbreak involves a visual screening, brief interview, and travel history. Individuals considered to have low or no risk of being contagious are allowed access into the country with no restrictions. Individuals who do not pass the initial screen undergo more extensive evaluation, including a physical examination and testing. Individuals deemed low risk after being tested are allowed access, whereas high-risk individuals are either isolated or quarantined in addition to receiving antiviral treatment or prophylaxis. doi:10.1128/microbiolspec.IOL5-0009-2015.f2

Source: microbiolspec October 2015 vol. 3 no. 5 doi:10.1128/microbiolspec.IOL5-0009-2015
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