Article
SARS transmission on commercial aircrafts, the German experience
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Published: | May 26, 2004 |
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Background: Since global surveillance of severe acute respiratory syndrome (SARS) started, suspect and probable cases have undertaken national and international travel by airplanes, thereby spreading the disease globally. However, the extent of the risk of in-flight transmission of SARS is unknown.
Methods: On 11 April 2003, a probable SARS case from Asia who had traveled extensively in Europe after onset of symptoms was identified. The passenger was RT-PCR positive for SARS-coronavirus. Passenger manifests from all flights were requested for all those seated 4 rows in front and behind the index case. A cohort study with passengers living in Germany was conducted. Information on demographics, flight details and symptoms was ascertained using a interviewer administered questionnaire and blood samples were tested (immunofluorescence assay) for SARS-coronavirus antibodies.
Results. In total 250 passengers from seven flights were identified. For 109 contact information was available. Among 71 residing in Germany, 62 were contacted and 41 (66%) agreed to participate. The final study sample included 36 passengers as five were lost to follow up. Passengers were contacted seven weeks after the flight. Results showed that none of the passengers reported illness and all serology samples were negative for SARS-coronavirus IgG antibodies.
Conclusions: No transmission of SARS was observed among contacted passengers on the indicated flights. However, given the limitations of the study (small sample size, convenience sample), it cannot be ruled out that transmission might have occurred. The study highlights that in public health emergencies such as SARS, the role of public health authorities and the aviation industry should be clearly defined to harmonize the protection of public health without the need to avoid unnecessary disruption of trade and travel. We recommend strengthening the collaboration between national health authorities and the airline industry. Furthermore, the International Air Transport Association should establish procedures to assure rapid and complete contact tracing of passengers in case of potential exposure to infectious diseases such as SARS, influenza, and tuberculosis.