Skip to main content Accessibility help
×
×
Home

Transmission routes of influenza A(H1N1)pdm09: analyses of inflight outbreaks

  • H. Lei (a1) (a2), J. W. Tang (a3) (a4) and Y. Li (a2)

Abstract

Knowledge about the infection transmission routes is significant for developing effective intervention strategies. We searched the PubMed databases and identified 10 studies with 14 possible inflight influenza A(H1N1)pdm09 outbreaks. Considering the different mechanisms of the large-droplet and airborne routes, a meta-analysis of the outbreak data was carried out to study the difference in attack rates for passengers within and beyond two rows of the index case(s). We also explored the relationship between the attack rates and the flight duration and/or total infectivity of the index case(s). The risk ratios for passengers seated within and beyond the two rows of the index cases were 1.7 (95% confidence interval (CI) 0.98–2.84) for syndromic secondary cases and 4.3 (95% CI 1.25–14.54) for laboratory-confirmed secondary cases. Furthermore, with an increase of the product of the flight duration and the total infectivity of the index cases, the overall attack rate increased linearly. The study indicates that influenza A(H1N1)pdm09 may mainly be transmitted via the airborne route during air travel. A standardised approach for the reporting of such inflight outbreak investigations would help to provide more convincing evidence for such inflight transmission events.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Transmission routes of influenza A(H1N1)pdm09: analyses of inflight outbreaks
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Transmission routes of influenza A(H1N1)pdm09: analyses of inflight outbreaks
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Transmission routes of influenza A(H1N1)pdm09: analyses of inflight outbreaks
      Available formats
      ×

Copyright

Corresponding author

Author for correspondence: H. Lei, E-mail: u3002926@connect.hku.hk

References

Hide All
1.Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team (2009) Emergence of a novel swine-origin influenza A (H1N1) virus in humans. New England Journal of Medicine 360, 26052615.
2.Khan, K et al. (2009) Spread of a novel influenza A (H1N1) virus via global airline transportation. New England Journal of Medicine 361, 212214.
3.Smith, W, Andrewes, CH and Laidlaw, PP (1933) A virus obtained from influenza patients. The Lancet 222, 6668.
4.Brankston, G et al. (2007) Transmission of influenza A in human beings. The Lancet Infectious Diseases 7, 257265.
5.Weber, TP and Stilianakis, NI (2008) Inactivation of influenza A viruses in the environment and modes of transmission: a critical review. Journal of Infection 57, 361373.
6.Mangili, A and Gendreau, MA (2005) Transmission of infectious diseases during commercial air travel. The Lancet 365, 989996.
7.Wagner, BG, Coburn, BJ and Blower, S (2009) Calculating the potential for within-flight transmission of influenza A (H1N1). BMC Medicine 7, e81.
8.Bean, B et al. (1982) Survival of influenza viruses on environmental surfaces. Journal of Infectious Diseases 146, 4751.
9.Schurmann, W and Eggers, HJ (1983) Antiviral activity of an alcoholic hand disinfectant. Comparison of the in vitro suspension test with in vivo experiments on hands, and on individual fingertips. Antiviral Research 3, 2541.
10.Atkinson, MP and Wein, LM (2008) Quantifying the routes of transmission for pandemic influenza. Bulletin of Mathematical Biology 70, 820867.
11.Lei, H et al. (2018) Routes of transmission of influenza A H1N1, SARS CoV, and norovirus in air cabin: comparative analyses. Indoor Air 28, 394403.
12.Liu, L et al. (2017) Short-range airborne transmission of expiratory droplets between two people. Indoor Air 27, 452462.
13.Leitmeyer, K and Adlhoch, C (2016) Review article: influenza transmission on aircraft: a systematic literature review. Epidemiology 27, 743.
14.Cao, B et al. (2009) Clinical and epidemiologic characteristics of 3 early cases of influenza A pandemic (H1N1) 2009 virus infection, People's Republic of China, 2009. Emerging Infectious Diseases 15, 1418.
15.Català, L et al. (2012) Pandemic A/H1N1 influenza: transmission of the first cases in Spain. Enfermedades Infecciosas Y Microbiología Clínica 30, 6063.
16.Zhang, L et al. (2013) Protection by face masks against influenza A (H1N1) pdm09 virus on trans-pacific passenger aircraft, 2009. Emerging Infectious Diseases 19, 14031410.
17.Centres for Disease Control and Prevention (2009) Swine-origin influenza A (H1N1) virus infections in a school – New York City, April 2009. MMWR Morbidity and Mortality Weekly Report 58, 470472.
18.Centres for Disease Control and Prevention (2009) Outbreak of swine origin influenza A (H1N1) virus infection – Mexico, March–April 2009. MMWR Morbidity and Mortality Weekly Report 58, 467–70.
19.Foxwell, AR et al. (2011) Transmission of influenza on international flights, May 2009. Emerging Infectious Diseases 17, 11881194.
20.Baker, MG et al. (2010) Transmission of pandemic A/H1N1 2009 influenza on passenger aircraft: retrospective cohort study. British Medical Journal 340, c2424.
21.Lee, N et al. (2009) Viral loads and duration of viral shedding in adult patients hospitalized with influenza. Journal of Infectious Diseases 200, 492500.
22.Centres for Disease Control and Prevention (2009) Swine influenza A (H1N1) infection in two children – Southern California, March–April 2009. MMWR Morbidity and Mortality Weekly Report 58, 400402.
23.Kim, JH et al. (2010) In-flight transmission of novel influenza A (H1N1). Epidemiology and Health 32, e2010006.
24.Word Heath Organization (2009) WHO technical advice for case management of influenza A (H1N1) in air transport. Available at: http://www.who.int/ihr/travel/A(H1N1)_air_transport_guidance.pdf.
25.Han, K et al. (2009) Lack of airborne transmission during outbreak of pandemic (H1N1) 2009 among tour group members, China, June 2009. Emerging Infectious Diseases 15, 15781581.
26.Neatherlin, J et al. (2013) Influenza A (H1N1) pdm09 during air travel. Travel Medicine & Infectious Disease 11, 110118.
27.Carrat, F et al. (2008) Time lines of infection and disease in human influenza: a review of volunteer challenge studies. American Journal of Epidemiology 167, 775–85.
28.Cowling, BJ et al. (2010) Comparative epidemiology of pandemic and seasonal influenza A in households. New England Journal of Medicine 362, 21752184.
29.Tsang, TK et al. (2015) Influenza A virus shedding and infectivity in households. Journal of Infectious Disease 212, 14201428.
30.Dennis, KMIp, et al. (2015) The dynamic relationship between clinical symptomatology and viral shedding in naturally acquired seasonal and pandemic influenza virus infections. Clinical Infectious Diseases 62, 431437.
31.Ooi, PL et al. (2010) Clinical and molecular evidence for transmission of novel influenza A (H1N1/2009) on a commercial airplane. Archives of Internal Medicine 170, 913.
32.Young, N et al. (2014) International flight-related transmission of pandemic influenza A(H1N1) pdm09: an historical cohort study of the first identified cases in the United Kingdom. Influenza & Other Respiratory Viruses 8, 6673.
33.Shankar, AG et al. (2014) Contact tracing for influenza A (H1N1) pdm09 virus-infected passenger on international flight. Emerging Infectious Diseases 20, 118120.
34.Nicas, M and Sun, G (2006) An integrated model of infection risk in a health-care environment. Risk Analysis 26, 10851096.
35.Nielsen, PV et al. (2008) Contaminant flow in the microenvironment between people under different ventilation conditions. ASHRAE Transactions 114, 632638.
36.Gupta, JK, Lin, CH and Chen, Q (2011) Transport of expiratory droplets in an aircraft cabin. Indoor Air 21, 311.
37.Moser, MR et al. (1979) An outbreak of influenza aboard a commercial airliner. American Journal of Epidemiology 110, 16.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
WORD
Supplementary materials

Lei et al. supplementary material
Lei et al. supplementary material 1

 Word (38 KB)
38 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed