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Tay M, Lee B, Ismail MH, Yam J, Maliki D, Gin KYH, Chae SR, Ho ZJM, Teoh YL, Ng LC, Wong JCC. Usefulness of aircraft and airport wastewater for monitoring multiple pathogens including SARS-CoV-2 variants. J Travel Med 2024; 31:taae074. [PMID: 38813965 DOI: 10.1093/jtm/taae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/17/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND As global travel resumed in coronavirus disease 2019 (COVID-19) endemicity, the potential of aircraft wastewater monitoring to provide early warning of disease trends for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and other infectious diseases, particularly at international air travel hubs, was recognized. We therefore assessed and compared the feasibility of testing wastewater from inbound aircraft and airport terminals for 18 pathogens including SARS-CoV-2 in Singapore, a popular travel hub in Asia. METHODS Wastewater samples collected from inbound medium- and long-haul flights and airport terminals were tested for SARS-CoV-2. Next Generation Sequencing was carried out on positive samples to identify SARS-CoV-2 variants. Airport and aircraft samples were further tested for 17 other pathogens through quantitative reverse transcription polymerase chain reaction. RESULTS The proportion of SARS-CoV-2-positive samples and the average virus load was higher for wastewater samples from aircraft as compared with airport terminals. Cross-correlation analyses indicated that viral load trends from airport wastewater led local COVID-19 case trends by 2-5 days. A total of 10 variants (44 sub-lineages) were successfully identified from aircraft wastewater and airport terminals, and four variants of interest and one variant under monitoring were detected in aircraft and airport wastewater 18-31 days prior to detection in local clinical cases. The detection of five respiratory and four enteric viruses in aircraft wastewater samples further underscores the potential to expand aircraft wastewater to monitoring pathogens beyond SARS-CoV-2. CONCLUSION Our findings demonstrate the feasibility of aircraft wastewater testing for monitoring infectious diseases threats, potentially detecting signals before clinical cases are reported. The triangulation of similar datapoints from aircraft wastewater of international travel nodes could therefore serve as a useful early warning system for global health threats.
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Affiliation(s)
- Martin Tay
- Environmental Health Institute, National Environment Agency, Singapore
| | - Benjamin Lee
- Environmental Health Institute, National Environment Agency, Singapore
| | | | - Jerald Yam
- Environmental Health Institute, National Environment Agency, Singapore
| | | | - Karina Yew-Hoong Gin
- NUS Environmental Research Institute, National University of Singapore, Singapore
- Energy and Environmental Sustainability for Megacities (E2S2) Phase II, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
- Department of Civil & Environmental Engineering, National University of Singapore, Singapore
| | - Sae-Rom Chae
- Communicable Diseases Group, Ministry of Health, Singapore
- National Centre for Infectious Diseases, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Yee Leong Teoh
- Communicable Diseases Group, Ministry of Health, Singapore
- National Centre for Infectious Diseases, Singapore
| | - Lee Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore
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Ruuskanen O, Dollner H, Luoto R, Valtonen M, Heinonen OJ, Waris M. Contraction of Respiratory Viral Infection During air Travel: An Under-Recognized Health Risk for Athletes. SPORTS MEDICINE - OPEN 2024; 10:60. [PMID: 38776030 PMCID: PMC11111432 DOI: 10.1186/s40798-024-00725-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
Air travel has an important role in the spread of viral acute respiratory infections (ARIs). Aircraft offer an ideal setting for the transmission of ARI because of a closed environment, crowded conditions, and close-contact setting. Numerous studies have shown that influenza and COVID-19 spread readily in an aircraft with one virus-positive symptomatic or asymptomatic index case. The numbers of secondary cases differ markedly in different studies most probably because of the wide variation of the infectiousness of the infector as well as the susceptibility of the infectees. The primary risk factor is sitting within two rows of an infectious passenger. Elite athletes travel frequently and are thus prone to contracting an ARI during travel. It is anecdotally known in the sport and exercise medicine community that athletes often contract ARI during air travel. The degree to which athletes are infected in an aircraft by respiratory viruses is unclear. Two recent studies suggest that 8% of Team Finland members traveling to major winter sports events contracted the common cold most probably during air travel. Further prospective clinical studies with viral diagnostics are needed to understand the transmission dynamics and to develop effective and socially acceptable preventive measures during air travel.
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Affiliation(s)
- Olli Ruuskanen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, PL 52, 20521, Turku, Finland
| | - Henrik Dollner
- Department of Clinical and Molecular Medicine, Children's Clinic, St. Olavs University Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Raakel Luoto
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, PL 52, 20521, Turku, Finland
| | | | - Olli J Heinonen
- Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, Turku, Finland
| | - Matti Waris
- Institute of Biomedicine, University of Turku and Department of Clinical Virology, Turku University Hospital, Kiinamyllynkatu 10, 20520, Turku, Finland.
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3
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Lyu M, Liu K, Hall RW. Spatial Interaction Analysis of Infectious Disease Import and Export between Regions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:643. [PMID: 38791857 PMCID: PMC11120745 DOI: 10.3390/ijerph21050643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/07/2024] [Accepted: 05/12/2024] [Indexed: 05/26/2024]
Abstract
Human travel plays a crucial role in the spread of infectious disease between regions. Travel of infected individuals from one region to another can transport a virus to places that were previously unaffected or may accelerate the spread of disease in places where the disease is not yet well established. We develop and apply models and metrics to analyze the role of inter-regional travel relative to the spread of disease, drawing from data on COVID-19 in the United States. To better understand how transportation affects disease transmission, we established a multi-regional time-varying compartmental disease model with spatial interaction. The compartmental model was integrated with statistical estimates of travel between regions. From the integrated model, we derived a transmission import index to assess the risk of COVID-19 transmission between states. Based on the index, we determined states with high risk for disease spreading to other states at the scale of months, and we analyzed how the index changed over time during 2020. Our model provides a tool for policymakers to evaluate the influence of travel between regions on disease transmission in support of strategies for epidemic control.
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Affiliation(s)
- Mingdong Lyu
- National Renewable Energy Laboratory, Mobility, Behavior, and Advanced Powertrains Department, Denver, CO 80401, USA
| | - Kuofu Liu
- Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA 90089, USA; (K.L.); (R.W.H.)
| | - Randolph W. Hall
- Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA 90089, USA; (K.L.); (R.W.H.)
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4
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Napolitano JM, Srikanth S, Noorai RE, Wilson S, Williams KE, Rosales-Garcia RA, Krueger B, Emerson C, Parker S, Pruitt J, Dango R, Iyer L, Shafi A, Jayawardena I, Parkinson CL, McMahan C, Rennert L, Peng CA, Dean D. SARS-CoV-2 variant introduction following spring break travel and transmission mitigation strategies. PLoS One 2024; 19:e0301225. [PMID: 38722935 PMCID: PMC11081374 DOI: 10.1371/journal.pone.0301225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/12/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND University spring break carries a two-pronged SARS-CoV-2 variant transmission risk. Circulating variants from universities can spread to spring break destinations, and variants from spring break destinations can spread to universities and surrounding communities. Therefore, it is critical to implement SARS-CoV-2 variant surveillance and testing strategies to limit community spread before and after spring break to mitigate virus transmission and facilitate universities safely returning to in-person teaching. METHODS We examined the SARS-CoV-2 positivity rate and changes in variant lineages before and after the university spring break for two consecutive years. 155 samples were sequenced across four time periods: pre- and post-spring break 2021 and pre- and post-spring break 2022; following whole genome sequencing, samples were assigned clades. The clades were then paired with positivity and testing data from over 50,000 samples. RESULTS In 2021, the number of variants in the observed population increased from four to nine over spring break, with variants of concern being responsible for most of the cases; Alpha percent composition increased from 22.2% to 56.4%. In 2022, the number of clades in the population increased only from two to three, all of which were Omicron or a sub-lineage of Omicron. However, phylogenetic analysis showed the emergence of distantly related sub-lineages. 2022 saw a greater increase in positivity than 2021, which coincided with a milder mitigation strategy. Analysis of social media data provided insight into student travel destinations and how those travel events may have impacted spread. CONCLUSIONS We show the role that repetitive testing can play in transmission mitigation, reducing community spread, and maintaining in-person education. We identified that distantly related lineages were brought to the area after spring break travel regardless of the presence of a dominant variant of concern.
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Affiliation(s)
- Justin M. Napolitano
- Clemson University, Research and Education in Disease Diagnostics and Intervention Clemson, Clemson, South Carolina, United States of America
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Sujata Srikanth
- Clemson University, Research and Education in Disease Diagnostics and Intervention Clemson, Clemson, South Carolina, United States of America
| | - Rooksana E. Noorai
- Clemson University, Clemson University Genomics and Bioinformatics Facility, Clemson, South Carolina, United States of America
| | - Stevin Wilson
- Clemson University, Clemson University Genomics and Bioinformatics Facility, Clemson, South Carolina, United States of America
- Illumina, San Diego, California, United States of America
| | - Kaitlyn E. Williams
- Clemson University, Clemson University Genomics and Bioinformatics Facility, Clemson, South Carolina, United States of America
- Clemson University, Center for Human Genetics, Greenwood, South Carolina, United States of America
| | - Ramses A. Rosales-Garcia
- Clemson University, Clemson University Genomics and Bioinformatics Facility, Clemson, South Carolina, United States of America
- Department of Biological Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - Brian Krueger
- Labcorp, Burlington, North Carolina, United States of America
| | - Chloe Emerson
- Clemson University, Research and Education in Disease Diagnostics and Intervention Clemson, Clemson, South Carolina, United States of America
| | - Scott Parker
- Labcorp, Burlington, North Carolina, United States of America
| | - John Pruitt
- Labcorp, Burlington, North Carolina, United States of America
| | - Rachel Dango
- Labcorp, Burlington, North Carolina, United States of America
| | - Lax Iyer
- Labcorp, Burlington, North Carolina, United States of America
| | - Adib Shafi
- Labcorp, Burlington, North Carolina, United States of America
| | - Iromi Jayawardena
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - Christopher L. Parkinson
- Clemson University, Clemson University Genomics and Bioinformatics Facility, Clemson, South Carolina, United States of America
- Department of Biological Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - Christopher McMahan
- Clemson University, School of Mathematical and Statistical Sciences, Clemson, South Carolina, United States of America
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States of America
- Clemson University, Center for Public Health Modeling and Response, Clemson, South Carolina, United States of America
| | - Congyue Annie Peng
- Clemson University, Research and Education in Disease Diagnostics and Intervention Clemson, Clemson, South Carolina, United States of America
- Department of Bioengineering, Clemson University, Clemson, South Carolina, United States of America
| | - Delphine Dean
- Clemson University, Research and Education in Disease Diagnostics and Intervention Clemson, Clemson, South Carolina, United States of America
- Department of Bioengineering, Clemson University, Clemson, South Carolina, United States of America
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5
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Howkins J, Packer S, Walsh E, Kumar D, Edeghere O, Hickman M, Oliver I. Risk of transmission of SARS-CoV-2 on international flights, a retrospective cohort study using national surveillance data in England. BMC Infect Dis 2024; 24:174. [PMID: 38326781 PMCID: PMC10851503 DOI: 10.1186/s12879-024-09052-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND It is not yet fully understood to what extent in-flight transmission contributed to the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). This study aimed to determine the occurrence and extent of SARS-CoV-2 transmission in-flight and assess factors associated with transmission risk to inform future control strategies. METHODS Retrospective cohort study using data obtained from contact tracing of international flights arriving in England between 02/08/2021-15/10/2021. Transmission risk was estimated by calculating the secondary attack rate (SAR). Univariable and multivariable analyses of the SAR by specific risk factors was undertaken, including: number of in-flight index cases; number of symptomatic index cases; contact vaccination status; flight duration; proximity to the index case(s); contact age. RESULTS 11,307 index cases linked to 667,849 contacts with 5,289 secondary cases reported. In-flight SAR was 0.79% (95% CI: 0.77-0.81). Increasing numbers of symptomatic cases (when > 4 index cases compared to one index case aOR 1.85; 95% CI: 1.40-2.44) and seating proximity to an index case (seated within compared to outside of two rows OR 1.82; 95% CI: 1.50-2.22) were associated with increased risk of secondary cases. Full vaccination history was protective (aOR 0.52; 95% CI: 0.47-0.57). CONCLUSIONS This study confirms that in-flight transmission of SARS-CoV-2 occurred. There are factors associated with increased risk of infection. Contact tracing identified exposed persons who subsequently developed infection. A targeted approach to contact tracing passengers with the highest exposure risk could be an effective use of limited public health resources.
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Affiliation(s)
- Joshua Howkins
- UK Health Security Agency, 5th Floor, 10 South Colonnade, E14 4PU, London, UK.
| | - Simon Packer
- Health Protection Operations, UK Health Security Agency, 5th Floor, 10 South Colonnade, E14 4PU, London, UK
| | | | - Deepti Kumar
- UK Health Security Agency, 61 Colindale Avenue, NW9 5EQ, London, UK
| | - Obaghe Edeghere
- UK Health Security Agency, 61 Colindale Avenue, NW9 5EQ, London, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Isabel Oliver
- UK Health Security Agency, 5th Floor, 10 South Colonnade, E14 4PU, London, UK
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6
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Vyas N, Bennett A, Shaver N, Beck A, Zitiktye G, Whelan B, O’Regan R, Conway A, Skidmore B, Moher D, Little J. SARS-CoV-2 transmission risk for common group activities and settings: a living scoping review. Eur J Public Health 2024; 34:196-201. [PMID: 37995320 PMCID: PMC10843946 DOI: 10.1093/eurpub/ckad195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND While the modes of transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are well studied, the risk of transmission in various group settings or activities is less clear. This living scoping review aims to summarize the risk factors of coronavirus disease 2019 (COVID-19) spread in common group activities (e.g. social gatherings) or settings (e.g. schools, hospitals, shared workplaces) to understand the drivers of transmission and to inform a risk assessment profile tool for use of rapid antigen detection tests. METHODS We systematically searched electronic databases, MEDLINE and Embase, from January 2019 until February 2022. We included studies that evaluated the risk of SARS-CoV-2 transmission in activities and settings, deemed strategically important to government departments in Ireland, provided by the Department of Health (Ireland) Expert Advisory Group on Rapid Testing. RESULTS After screening 14 052 records, data from 139 studies were narratively synthesized. The risk was consistently reported as 'high' for large social events (e.g. weddings) and indoor sports, working in healthcare settings and shared workplaces, working/living in residential settings and travelling via public transportation. Most studies were from healthcare settings, with common risk factors including close contact with COVID-19 cases, working in high-risk departments and inappropriate use of personal protective equipment. For other settings and activities, lack of infection prevention and control practices reportedly contributed to infection transmission. CONCLUSION The heterogeneity across studies and lack of direct information on dominant variants, preventive measures, vaccination coverage necessitates further research on transmission risk within group activities to inform infection prevention and control measures.
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Affiliation(s)
- Niyati Vyas
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexandria Bennett
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicole Shaver
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Beck
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gabriele Zitiktye
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Barbara Whelan
- Evidence Synthesis Ireland & Cochrane Ireland, School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Rhea O’Regan
- Evidence Synthesis Ireland & Cochrane Ireland, School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Aileen Conway
- Evidence Synthesis Ireland & Cochrane Ireland, School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - David Moher
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julian Little
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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7
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Hui KPY, Chin AWH, Ehret J, Ng KC, Peiris M, Poon LLM, Wong KHM, Chan MCW, Hosegood I, Nicholls JM. Stability of SARS-CoV-2 on Commercial Aircraft Interior Surfaces with Implications for Effective Control Measures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6598. [PMID: 37623181 PMCID: PMC10454724 DOI: 10.3390/ijerph20166598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic from 2019 to 2022 devastated many aspects of life and the economy, with the commercial aviation industry being no exception. One of the major concerns during the pandemic was the degree to which the internal aircraft environment contributed to virus transmission between humans and, in particular, the stability of SARS-CoV-2 on contact surfaces in the aircraft cabin interior. METHOD In this study, the stability of various major strains of SARS-CoV-2 on interior aircraft surfaces was evaluated using the TCID50 assessment. RESULTS In contrast to terrestrial materials, SARS-CoV-2 was naturally less stable on common contact points in the aircraft interior, and, over a 4 h time period, there was a 90% reduction in culturable virus. Antiviral and surface coatings were extremely effective at mitigating the persistence of the virus on surfaces; however, their benefit was diminished by regular cleaning and were ineffective after 56 days of regular use and cleaning. Finally, successive strains of SARS-CoV-2 have not evolved to be more resilient to survival on aircraft surfaces. CONCLUSIONS We conclude that the mitigation strategies for SARS-CoV-2 on interior aircraft surfaces are more than sufficient, and epidemiological evidence over the past three years has not found that surface spread is a major route of transmission.
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Affiliation(s)
- Kenrie P. Y. Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam HKG, Hong Kong SAR, China; (K.P.Y.H.)
- Centre for Immunology & Infection, Hong Kong Science Park HKG, Hong Kong SAR, China
| | - Alex W. H. Chin
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam HKG, Hong Kong SAR, China; (K.P.Y.H.)
- Centre for Immunology & Infection, Hong Kong Science Park HKG, Hong Kong SAR, China
| | - John Ehret
- Qantas Airways Ltd., Qantas 10 Bourke Rd Mascot, Sydney, NSW 2020, Australia
| | - Ka-Chun Ng
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam HKG, Hong Kong SAR, China; (K.P.Y.H.)
| | - Malik Peiris
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam HKG, Hong Kong SAR, China; (K.P.Y.H.)
- Centre for Immunology & Infection, Hong Kong Science Park HKG, Hong Kong SAR, China
| | - Leo L. M. Poon
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam HKG, Hong Kong SAR, China; (K.P.Y.H.)
- Centre for Immunology & Infection, Hong Kong Science Park HKG, Hong Kong SAR, China
| | - Karen H. M. Wong
- Electron Microscopy Unit, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam HKG, Hong Kong SAR, China
| | - Michael C. W. Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam HKG, Hong Kong SAR, China; (K.P.Y.H.)
- Centre for Immunology & Infection, Hong Kong Science Park HKG, Hong Kong SAR, China
| | - Ian Hosegood
- Qantas Airways Ltd., Qantas 10 Bourke Rd Mascot, Sydney, NSW 2020, Australia
| | - John M. Nicholls
- Department of Pathology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam HKG, Hong Kong SAR, China
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8
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Schijven JF, van Veen T, Delmaar C, Kos J, Vermeulen L, Roosien R, Verhoeven F, Schipper M, Peerlings B, Duizer E, Derei J, Lammen W, Bartels O, van der Ven H, Maas R, de Roda Husman AM. Quantitative Microbial Risk Assessment of Contracting COVID-19 Derived from Measured and Simulated Aerosol Particle Transmission in Aircraft Cabins. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:87011. [PMID: 37589660 PMCID: PMC10434022 DOI: 10.1289/ehp11495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND SARS-CoV-2 can be effectively transmitted between individuals located in close proximity to each other for extended durations. Aircraft provide such conditions. Although high attack rates during flights were reported, little was known about the risk levels of aerosol transmission of SARS-CoV-2 in aircraft cabins. OBJECTIVES The major objective was to estimate the risk of contracting COVID-19 from transmission of aerosol particles in aircraft cabins. METHODS In two single-aisle and one twin-aisle aircraft, dispersion of generated aerosol particles over a seven-row economy class cabin section was measured under cruise and taxi conditions and simulated with a computational fluid dynamic model under cruise conditions. Using the aerosol particle dispersion data, a quantitative microbial risk assessment was conducted for scenarios with an asymptomatic infectious person expelling aerosol particles by breathing and speaking. Effects of flight conditions were evaluated using generalized additive mixed models. RESULTS Aerosol particle concentration decreased with increasing distance from the infectious person, and this decrease varied with direction. On a typical flight with an average shedder, estimated mean risk of contracting COVID-19 ranged from 1.3 × 10 - 3 to 9.0 × 10 - 2 . Risk increased to 7.7 × 10 - 2 with a super shedder (< 3 % of cases) on a long flight. Risks increased with increasing flight duration: 2-23 cruise flights of typical duration and 2-10 flights of longer duration resulted in at least 1 case of COVID-19 due to onboard aerosol transmission by one average shedder, and in the case of one super shedder, at least 1 case in 1-3 flights of typical duration cruise and 1 flight of longer duration. DISCUSSION Our findings indicate that the risk of contracting COVID-19 by aerosol transmission in an aircraft cabin is low, but it will not be zero. Testing before boarding may help reduce the chance of a (super)shedder boarding an aircraft and mask use further reduces aerosol transmission in the aircraft cabin. https://doi.org/10.1289/EHP11495.
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Affiliation(s)
- Jack F. Schijven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department of Earth Sciences, Utrecht University, Utrecht, the Netherlands
| | - Theo van Veen
- Royal Netherlands Aerospace Centre, Amsterdam, the Netherlands
| | - Christiaan Delmaar
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Johan Kos
- Royal Netherlands Aerospace Centre, Amsterdam, the Netherlands
| | - Lucie Vermeulen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Rui Roosien
- Royal Netherlands Aerospace Centre, Amsterdam, the Netherlands
| | | | - Maarten Schipper
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bram Peerlings
- Royal Netherlands Aerospace Centre, Amsterdam, the Netherlands
| | - Erwin Duizer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jonathan Derei
- Royal Netherlands Aerospace Centre, Amsterdam, the Netherlands
| | - Wim Lammen
- Royal Netherlands Aerospace Centre, Amsterdam, the Netherlands
| | - Onno Bartels
- Royal Netherlands Aerospace Centre, Amsterdam, the Netherlands
| | | | - Robert Maas
- Royal Netherlands Aerospace Centre, Amsterdam, the Netherlands
| | - Ana Maria de Roda Husman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
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9
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Mothershead JL, Dembek ZF, Hadeed SJ, Schwartz-Watjen KT, Broadway KM, Tigabu B, Woodards AJ, Owens AN, Chekol T, Wu A. A Universal Travel Risk Assessment Questionnaire: Travel Assessment During COVID-19 Pandemic and Endemicity. Mil Med 2023; 188:e2606-e2614. [PMID: 36065513 DOI: 10.1093/milmed/usac261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/26/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Throughout the Coronavirus Disease 2019 (COVID-19) pandemic, military commanders have been challenged with providing appropriate travel guidance for their military and civilian personnel and dependents. This guidance, where promulgated, lacks uniformity. Travel aids and computer applications similarly differ and are not updated as often as jurisdictional travel health guidance is changed. Given the ever-evolving Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants with differing degrees of infectivity, COVID-19 travel guidance will remain relevant for military travelers during the transition from pandemic to endemic phases and for the foreseeable future. MATERIALS AND METHODS We reviewed all germane travel guidance promulgated by the U.S, Department of Defense; the U.S. Centers for Disease Control and Prevention; and other federal, state, and international agencies. From these materials, we identified and delineated applicable universal components for COVID-19 travel risk and created a universal Travel Risk Assessment Questionnaire (TRAQ). RESULTS We present a universal TRAQ that identifies and allows for a graded most-appropriate response to known travel risk assessment factors including travel restrictions, travel mode, travel time, travel party size, trip duration, COVID-19 incidence rate at travel destination, lodging, planned activities, personal interaction level, vaccination coverage at destination, travel location, traveler's vaccination status, previous COVID-19 infection, mask wear compliance, mask type, and work environment, along with additional considerations and post-travel COVID-19 questions. We provide examples of the use of this questionnaire that describe low, medium, and high risk to the traveler for contracting COVID-19. CONCLUSION Our TRAQ provides an easy-to-use format that can enable military, business, or personal travelers to more completely assess their likelihood of COVID-19 exposure and help them to reduce their potential for contracting COVID-19 during travel and subsequently transmitting it to others upon return. It should help commanders and traveling personnel to better assess COVID-19 travel risks through application of known travel risk factors.
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Affiliation(s)
- Jerry L Mothershead
- Applied Research Associates (ARA), Support to DTRA Technical Reachback, Albuquerque, NM 87110, USA
| | - Zygmunt F Dembek
- Battelle Memorial Institute, Support to DTRA Technical Reachback, Columbus, OH 43201, USA
- Guarantor
| | - Steven J Hadeed
- Battelle Memorial Institute, Support to DTRA Technical Reachback, Columbus, OH 43201, USA
| | | | - Katherine M Broadway
- Defense Sciences, Inc. (DSI), Support to DTRA Technical Reachback, San Antonio, TX 78230, USA
| | - Bersabeh Tigabu
- Global Systems Engineering, Support to DTRA Technical Reachback, Alexandria, VA 22312, USA
| | - Ashley J Woodards
- Battelle Memorial Institute, Support to DTRA Technical Reachback, Columbus, OH 43201, USA
| | - Akeisha N Owens
- Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA 22060, USA
| | - Tesema Chekol
- Battelle Memorial Institute, Support to DTRA Technical Reachback, Columbus, OH 43201, USA
| | - Aiguo Wu
- Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA 22060, USA
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10
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Freedman DO. Air travel and SARS-CoV-2: many remaining knowledge gaps. J Travel Med 2022; 29:6775351. [PMID: 36300503 PMCID: PMC9620362 DOI: 10.1093/jtm/taac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/29/2022]
Abstract
50-word teaser: COVID-19 is with us indefinitely and air travel is a necessity. Needed research has lagged due to pandemic disruption but must not stall due to COVID indifference. A US government report proposes that national aviation authorities, not health agencies, take the lead. Research priorities and study designs are proposed.
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Affiliation(s)
- David O Freedman
- Professor Emeritus of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
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11
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Sun X, Wandelt S, Zhang A. COVID-19 pandemic and air transportation: Summary of Recent Research, Policy Consideration and Future Research Directions. TRANSPORTATION RESEARCH INTERDISCIPLINARY PERSPECTIVES 2022; 16:100718. [PMID: 36407295 PMCID: PMC9640395 DOI: 10.1016/j.trip.2022.100718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 05/19/2023]
Abstract
The COVID-19 pandemic can be considered an unparalleled disruption to the aviation industry in the last century. Starting with an at-that-time inconceivable reduction in the number of flights from March 2020 to May 2020, the aviation industry has been trying to navigate through and out of the crisis. This process is accompanied with a significant number of scientific studies, reporting on the direct and indirect impact of the COVID-19 pandemic on aviation and vice versa. This paper reviews the impacts in context of the recent literature. We have collected nearly 200 well-published papers on the subject in the years 2021/2022 and dissected them into a framework of eight categories, built around: airlines, airports, passengers, workforce, markets, contagion, sustainability, and economics. We highlight the essence of findings in the literature and derive a set of future research directions and policy considerations which we deem important on the way towards pandemic-resilient aviation.
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Affiliation(s)
- Xiaoqian Sun
- National Key Laboratory of CNS/ATM, School of Electronic and Information Engineering, Beihang University, 100191 Beijing, China
| | - Sebastian Wandelt
- National Key Laboratory of CNS/ATM, School of Electronic and Information Engineering, Beihang University, 100191 Beijing, China
| | - Anming Zhang
- Sauder School of Business, University of British Columbia, Vancouver, BC, Canada
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12
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Moek F, Rohde A, Schöll M, Seidel J, Baum JHJ, der Heiden MA. Attack Rate for Wild-Type SARS-CoV-2 during Air Travel: Results from 46 Flights Traced by German Health Authorities, January-March and June-August 2020. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:8364666. [PMID: 36317155 PMCID: PMC9617719 DOI: 10.1155/2022/8364666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/19/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022]
Abstract
Background Evidence on the risk of SARS-CoV-2 transmission during air travel is scarce. We aimed to estimate the attack rate for wild-type SARS-CoV-2 to improve the evidence base for the adaptation of nonpharmaceutical intervention (NPI) strategies aboard airplanes. Methods In collaboration with German Public Health Authorities (PHA), we conducted a follow-up of in-flight SARS-CoV-2 contact persons. We included those contact persons whom the Emergency Operations Centre at the Robert Koch-Institute had forwarded to PHA between January to March 2020 (before masking on flights became mandatory) and June to August 2020 (after the introduction of mandatory masking). We retrospectively collected data on whether these contact persons had been successfully contacted, had become symptomatic and had been tested for SARS-CoV-2, and whether alternative exposures other than the flight were known. Results Complete data that allowed for the calculation of attack rates were available for 108 contact persons (median age of 36 (IQR 24-53), 40% female), traveling on 46 flights with a median flight duration of 3 hours (IQR 2-3.5). 62 of these persons travelled after masking on flights became mandatory. 13/87 developed symptoms, 44/77 were tested (no data for 21 and 31). 13 persons (9 of whom had been SARS-CoV-2 positive) were excluded from the analysis of attack rates due to a likely alternative exposure. We thus identified 4 probable in-flight transmissions (2 of which occurred after the introduction of mandatory masking). The overall attack rate resulted in 4.2% (4/95; 95% CI: 1.4%-11.0%). Considering flights after mandatory masking, the attack rate was 3.6% (2/56, 95% CI 0.6%-13.4%), before masking 5.1% (2/39, 95% CI 0.9%-18.6%). Conclusions The risk of wild-type SARS-CoV-2 transmission during air travel seemed low, but not negligible. In order to formulate an effective, evidence-based NPI protocol for air travel, further studies considering the different transmissibility of SARS-CoV-2 variants of concern and vaccination status are needed.
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Affiliation(s)
- Felix Moek
- Postgraduate Training for Applied Epidemiology (PAE), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anna Rohde
- Unit for Gastrointestinal Infections, Zoonoses and Tropical Infections (Unit 35), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Meike Schöll
- Postgraduate Training for Applied Epidemiology (PAE), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Unit for Crisis Management, Outbreak Investigations and Training Programmes, Focal Point for the Public Health Service (Unit 38), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Juliane Seidel
- Unit for Crisis Management, Outbreak Investigations and Training Programmes, Focal Point for the Public Health Service (Unit 38), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Jonathan H. J. Baum
- Postgraduate Training for Applied Epidemiology (PAE), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Maria an der Heiden
- Unit for Crisis Management, Outbreak Investigations and Training Programmes, Focal Point for the Public Health Service (Unit 38), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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13
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Rosca EC, Heneghan C, Spencer EA, Brassey J, Plüddemann A, Onakpoya IJ, Evans D, Conly JM, Jefferson T. Transmission of SARS-CoV-2 Associated with Cruise Ship Travel: A Systematic Review. Trop Med Infect Dis 2022; 7:290. [PMID: 36288031 PMCID: PMC9610645 DOI: 10.3390/tropicalmed7100290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Maritime and river travel may be associated with respiratory viral spread via infected passengers and/or crew and potentially through other transmission routes. The transmission models of SARS-CoV-2 associated with cruise ship travel are based on transmission dynamics of other respiratory viruses. We aimed to provide a summary and evaluation of relevant data on SARS-CoV-2 transmission aboard cruise ships, report policy implications, and highlight research gaps. Methods: We searched four electronic databases (up to 26 May 2022) and included studies on SARS-CoV-2 transmission aboard cruise ships. The quality of the studies was assessed based on five criteria, and relevant findings were reported. Results: We included 23 papers on onboard SARS-CoV-2 transmission (with 15 reports on different aspects of the outbreak on Diamond Princess and nine reports on other international cruises), 2 environmental studies, and 1 systematic review. Three articles presented data on both international cruises and the Diamond Princess. The quality of evidence from most studies was low to very low. Index case definitions were heterogeneous. The proportion of traced contacts ranged from 0.19 to 100%. Studies that followed up >80% of passengers and crew reported attack rates (AR) up to 59%. The presence of a distinct dose−response relationship was demonstrated by findings of increased ARs in multi-person cabins. Two studies performed viral cultures with eight positive results. Genomic sequencing and phylogenetic analyses were performed in individuals from three cruises. Two environmental studies reported PCR-positive samples (cycle threshold range 26.21−39.00). In one study, no infectious virus was isolated from any of the 76 environmental samples. Conclusion: Our review suggests that crowding and multiple persons per cabin were associated with an increased risk of transmission on cruise ships. Variations in design, methodology, and case ascertainment limit comparisons across studies and quantification of transmission risk. Standardized guidelines for conducting and reporting studies on cruise ships of acute respiratory infection transmission should be developed.
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Affiliation(s)
- Elena Cecilia Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy, Piata Eftimie Murgu 2, 300041 Timisoara, Romania
| | - Carl Heneghan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Elizabeth A. Spencer
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Jon Brassey
- Trip Database Ltd., Glasllwch Lane, Newport NP20 3PS, UK
| | - Annette Plüddemann
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Igho J. Onakpoya
- Department for Continuing Education, University of Oxford, Rewley House, 1 Wellington Square, Oxford OX1 2JA, UK
| | - David Evans
- Li Ka Shing Institute of Virology, and Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - John M. Conly
- Departments of Medicine, Microbiology, Immunology & Infectious Diseases, and Pathology & Laboratory Medicine, Synder Institute for Chronic Diseases and O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 4N1, Canada
| | - Tom Jefferson
- Department for Continuing Education, University of Oxford, Rewley House, 1 Wellington Square, Oxford OX1 2JA, UK
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14
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Ngeh S, Vogt F, Sikazwe CT, Levy A, Pingault NM, Smith DW, Effler PV. Travel-associated SARS-CoV-2 transmission documented with whole genome sequencing following a long-haul international flight. J Travel Med 2022; 29:6582210. [PMID: 35532195 PMCID: PMC9129214 DOI: 10.1093/jtm/taac057] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/29/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Multiple instances of flight-associated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during long-haul flights have been reported during the COVID-19 pandemic. However, comprehensive investigations of passenger risk behaviours, before, during and after the flight, are scarce. METHODS To investigate suspected SARS-CoV-2 transmission during a flight from United Arab Emirates to Australia in July 2020, systematic, repeated polymerase chain reaction (PCR) testing of passengers in hotel quarantine was linked to whole genome sequencing. Epidemiological analyses of in-depth interviews covering behaviours during the flight and activities pre- and post-boarding were used to identify risk factors for infection. RESULTS Seventeen of the 95 passengers from four different travel origins had PCR-confirmed infection yielding indistinguishable genomic sequences. Two of the 17 passengers were symptomatic within 2 days of the flight, and classified as co-primary cases. Seven secondary cases were seated within two rows of the co-primary cases, but five economy passengers seated further away and three business class passengers were also infected (attack rate = 16% [15/93]). In multivariable analysis, being seated within two rows of a primary case [odds ratio (OR) 7.16; 95% confidence interval (CI) 1.66-30.85] and spending more than an hour in the arrival airport (OR 4.96; 95% CI 1.04-23.60) were independent predictors of secondary infection, suggesting travel-associated SARS-CoV-2 transmission likely occurred both during and after the flight. Self-reported increased hand hygiene, frequent aisle walking and using the bathroom on the plane did not independently affect the risk of SARS-CoV-2 acquisition. CONCLUSIONS This investigation identified substantial in-flight transmission among passengers seated both within and beyond two rows of the primary cases. Infection of passengers in separate cabin classes also suggests transmission occurred outside the cabin environment, likely at the arrival airport. Recognizing that transmission may occur pre- and post-boarding may inform contact tracing advice and improve efforts to prevent future travel-associated outbreaks.
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Affiliation(s)
- Sera Ngeh
- Communicable Disease Control Directorate, Department of Health Western Australia, PO Box 6172, Perth Business Centre, Perth, WA 6849, Australia.,National Centre for Epidemiology and Population Health, Australian National University, 62 Mills Road, Acton, Canberra ACT 2601, Australia
| | - Florian Vogt
- Communicable Disease Control Directorate, Department of Health Western Australia, PO Box 6172, Perth Business Centre, Perth, WA 6849, Australia.,National Centre for Epidemiology and Population Health, Australian National University, 62 Mills Road, Acton, Canberra ACT 2601, Australia.,Global Health Program, The Kirby Institute, Level 6, Wallace Wurth Building, High Street, University of New South Wales, Sydney, Kensington NSW 2052, Australia
| | - Chisha T Sikazwe
- Department of Microbiology, PathWest Laboratory Medicine Western Australia, QE2 Medical Centre, Locked Bay 2009, Nedlands, WA, 6909, Australia.,School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Avram Levy
- Department of Microbiology, PathWest Laboratory Medicine Western Australia, QE2 Medical Centre, Locked Bay 2009, Nedlands, WA, 6909, Australia.,School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Nevada M Pingault
- Communicable Disease Control Directorate, Department of Health Western Australia, PO Box 6172, Perth Business Centre, Perth, WA 6849, Australia
| | - David W Smith
- Department of Microbiology, PathWest Laboratory Medicine Western Australia, QE2 Medical Centre, Locked Bay 2009, Nedlands, WA, 6909, Australia.,School of Medicine, University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Paul V Effler
- Communicable Disease Control Directorate, Department of Health Western Australia, PO Box 6172, Perth Business Centre, Perth, WA 6849, Australia.,School of Medicine, University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
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15
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Barnett A, Fleming K. Covid-19 infection risk on US domestic airlines. Health Care Manag Sci 2022; 25:347-362. [PMID: 35779143 PMCID: PMC9474510 DOI: 10.1007/s10729-022-09603-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/30/2022] [Indexed: 11/08/2022]
Abstract
Working with recent data and research findings, we estimate the probability that an air traveler in economy class would have contracted Covid-19 on a US domestic jet flight over the nine-month period June 2020 to February 2021. The estimates take account of the rates of confirmed Covid-19 infections in the US, flight duration, fraction of seats occupied, and some demographic differences between US air travelers and US citizens as a whole. Based on point estimates, the risk of contracting Covid-19 in-flight exceeded 1 in 1000 on a fully-loaded two-hour flight at the height of the pandemic over the nine months, but was about 1 in 6000 on a half-full flight when the pandemic was at a low ebb. However, these estimates are subject to substantial uncertainty, with the 10th percentiles of various risk distributions only about 1/7 as large as the medians, and the 90th percentiles about four times as large. Based on seat-occupancy levels on US flights for each month over June 2020 to February 2021, the median risk estimate for that period is 1 in 2250, while the mean risk estimate is 1 in 1450. Indirect effects arose because those who contracted Covid-19 on US airplanes could in turn infect others.
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Affiliation(s)
- Arnold Barnett
- MIT Sloan School of Management, E62-568, MIT, Cambridge, MA 02142 USA
| | - Keith Fleming
- MIT Sloan School of Management, E62-568, MIT, Cambridge, MA 02142 USA
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16
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Travel in the Time of COVID: A Review of International Travel Health in a Global Pandemic. Curr Infect Dis Rep 2022; 24:129-145. [PMID: 35965881 PMCID: PMC9361911 DOI: 10.1007/s11908-022-00784-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/03/2022]
Abstract
Abstract
Purpose of Review
This review critically considers the impact of the COVID-19 pandemic on global travel and the practice of travel medicine, highlights key innovations that have facilitated the resumption of travel, and anticipates how travel medicine providers should prepare for the future of international travel.
Recent Findings
Since asymptomatic transmission of the virus was first recognized in March 2020, extensive efforts have been made to characterize the pattern and dynamics of SARS-CoV-2 transmission aboard commercial aircraft, cruise ships, rail and bus transport, and in mass gatherings and quarantine facilities. Despite the negative impact of further waves of COVID-19 driven by the more transmissible Omicron variant, rapid increases of international tourist arrivals are occurring and modeling anticipates further growth. Mitigation of spread requires an integrated approach that combines masking, physical distancing, improving ventilation, testing, and quarantine. Vaccines and therapeutics have played a significant role in reopening society and accelerating the resumption of travel and further therapeutic innovation is likely.
Summary
COVID-19 is likely to persist as an endemic infection, and surveillance will assume an even more important role. The pandemic has provided an impetus to advance technology for telemedicine, to adopt mobile devices and GPS in contact tracing, and to apply digital applications in research. The future of travel medicine should continue to harness these novel platforms in the clinical, research, and educational arenas.
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17
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Guo Q, Wang J, Estill J, Lan H, Zhang J, Wu S, Yao J, Yan X, Chen Y. Risk of COVID-19 Transmission Aboard Aircraft: An Epidemiological Analysis Based on the National Health Information Platform. Int J Infect Dis 2022; 118:270-276. [PMID: 35331931 PMCID: PMC8935959 DOI: 10.1016/j.ijid.2022.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/23/2022] [Accepted: 03/15/2022] [Indexed: 12/26/2022] Open
Abstract
Objectives This study aims to investigate the risk of COVID-19 transmission on aircraft. Methods We obtained data on all international flights to Lanzhou, China, from June 1, 2020, to August 1, 2020, through the Gansu Province National Health Information Platform and the official website of the Gansu Provincial Center for Disease Control and Prevention. We then performed the statistical analysis. Results Three international flights arrived in Lanzhou. The flights had a total of 700 passengers, of whom 405 (57.9%) were male, and 80 (11.4%) were children under the age of 14 years. Twenty-seven (3.9%) passengers were confirmed to have COVID-19. Confirmed patients were primarily male (17, 65.4%) with a median age of 27.0 years. Most confirmed cases were seated in the middle rows of economy class or near public facility areas such as restrooms and galleys. The prevalence of COVID-19 did not differ between passengers sitting in the window, aisle, or middle seats. However, compared with passengers sitting in the same row up to 2 rows behind a confirmed case, passengers seated in the 2 rows in front of a confirmed case were at a slightly higher risk of being infected. Conclusions COVID-19 may be transmitted during a passenger flight, although there is still no direct evidence.
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Affiliation(s)
- Qiangqiang Guo
- School of Public Health, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Jianjian Wang
- School of Public Health, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland; Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Hui Lan
- School of Public Health, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Juanjuan Zhang
- School of Public Health, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Shouyuan Wu
- School of Public Health, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Jingwen Yao
- Health Statistics Information Center of Health Commission of Gansu Province, Lanzhou, China
| | - Xuanchen Yan
- Health Statistics Information Center of Health Commission of Gansu Province, Lanzhou, China.
| | - Yaolong Chen
- School of Public Health, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.
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Lv Q, Kong D, He Y, Lu Y, Chen L, Zhao J, Feng S, Chen Y, Wan J, Wen Y, Gao W, Chen Z, Tang X, Mei S, Zou X, Feng T. A SARS-CoV-2 Delta variant outbreak on airplane: vaccinated air passengers are more protected than unvaccinated. J Travel Med 2021; 28:6381389. [PMID: 34609488 PMCID: PMC8522384 DOI: 10.1093/jtm/taab161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022]
Abstract
In-fight transmission of SARS-CoV-2 Delta variant could occur on airplane, and close contact is the main mode of transmission. Vaccination still protects against the Delta variant transmission.
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Affiliation(s)
- Qiuying Lv
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Dongfeng Kong
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Yaqing He
- Department of Pathogenic Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Yan Lu
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Long Chen
- Department of Pathogenic Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Jin Zhao
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Siyang Feng
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Yixiong Chen
- Department of Communicable Diseases Control and Prevention, Shenzhen Boan District Center for Disease Control and Prevention, Shenzhen 518001, China
| | - Jia Wan
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Ying Wen
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Wei Gao
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Zhigao Chen
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Xiujuan Tang
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Shujiang Mei
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Xuan Zou
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Tiejian Feng
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
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Haji Ali B, Shahin MS, Masoumi Sangani MM, Faghihinezhad M, Baghdadi M. Wastewater aerosols produced during flushing toilets, WWTPs, and irrigation with reclaimed municipal wastewater as indirect exposure to SARS-CoV-2. JOURNAL OF ENVIRONMENTAL CHEMICAL ENGINEERING 2021; 9:106201. [PMID: 34405082 PMCID: PMC8361049 DOI: 10.1016/j.jece.2021.106201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 05/07/2023]
Abstract
The detection of SARS-CoV-2 RNA in raw and treated wastewater can open up a fresh perspective to waterborne and aerosolized wastewater as a new transmission route of SARS-CoV-2 RNA during the current pandemic. The aim of this paper is to discuss the potential transmission of SARS-CoV-2 RNA from wastewater aerosols formed during toilet flushing, plumbing failure, wastewater treatment plants, and municipal wastewater reuse for irrigation. Moreover, how these aerosols might increase the risk of exposure to this novel coronavirus (SARS-CoV-2 RNA). This article supplies a review of the literature on the presence of SARS-CoV-2 RNA in untreated wastewater, as well as the fate and stability of SARS-CoV-2 RNA in wastewater. We also reviewed the existing literatures on generation and transmission of aerosolized wastewater through flush a toilet, house's plumbing networks, WWTPs, wastewater reuse for irrigation of agricultural areas. Finally, the article briefly studies the potential risk of infection with exposure to the fecal bioaerosols of SARS-CoV-2 RNA for the people who might be exposed through flushing toilets or faulty building plumbing systems, operators/workers in wastewater treatment plants, and workers of fields irrigated with treated wastewater - based on current knowledge. Although this review highlights the indirect transmission of SARS-CoV-2 RNA through wastewater aerosols, no research has yet clearly demonstrated the role of aerosolized wastewater in disease transmission regarding the continuation of this pandemic. Therefore, there is a need for additional studies on wastewater aerosols in transmission of COVID-19.
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Affiliation(s)
- Banafsheh Haji Ali
- School of Environment, College of Engineering, University of Tehran, Tehran, Iran
| | | | | | - Mohsen Faghihinezhad
- School of Environment, College of Engineering, University of Tehran, Tehran, Iran
| | - Majid Baghdadi
- School of Environment, College of Engineering, University of Tehran, Tehran, Iran
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