Transmission of the Severe Acute Respiratory Syndrome on Aircraft

Sonja J. Olsen, Hsiao Ling Chang, Terence Yung Yan Cheung, Antony Fai Yu Tang, Tamara L. Fisk, Steven Peng Lim Ooi, Hung Wei Kuo, Donald Dah Shyong Jiang, Kow Tong Chen, Jim Lando, Kwo Hsiung Hsu, Tzay Jinn Chen, Scott F. Dowell

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281 Citations (Scopus)

Abstract

BACKGROUND: The severe acute respiratory syndrome (SARS) spread rapidly around the world, largely because persons infected with the SARS-associated coronavirus (SARS-CoV) traveled on aircraft to distant cities. Although many infected persons traveled on commercial aircraft, the risk, if any, of in-flight transmission is unknown. METHODS: We attempted to interview passengers and crew members at least 10 days after they had taken one of three flights that transported a patient or patients with SARS. All index patients met the criteria of the World Health Organization for a probable case of SARS, and index or secondary cases were confirmed to be positive for SARS-COV on reverse-transcriptase polymerase chain reaction or serologic testing. RESULTS: After one flight carrying a symptomatic person and 119 other persons, laboratory-confirmed SARS developed in 16 persons, 2 others were given diagnoses of probable SARS, and 4 were reported to have SARS but could not be interviewed. Among the 22 persons with illness, the mean time from the flight to the onset of symptoms was four days (range, two to eight), and there were no recognized exposures to patients with SARS before or after the flight. Illness in passengers was related to the physical proximity to the index patient, with illness reported in 8 of the 23 persons who were seated in the three rows in front of the index patient, as compared with 10 of the 88 persons who were seated elsewhere (relative risk, 3.1; 95 percent confidence interval, 1.4 to 6.9). In contrast, another flight carrying four symptomatic persons resulted in transmission to at most one other person, and no illness was documented in passengers on the flight that carried a person who had presymptomatic SARS. CONCLUSIONS: Transmission of SARS may occur on an aircraft when infected persons fly during the symptomatic phase of illness. Measures to reduce the risk of transmission are warranted.

Original languageEnglish
Pages (from-to)2416-2422
Number of pages7
JournalNew England Journal of Medicine
Volume349
Issue number25
DOIs
Publication statusPublished - Dec 18 2003
Externally publishedYes

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Severe Acute Respiratory Syndrome
Aircraft
Coronavirus
Reverse Transcriptase Polymerase Chain Reaction

ASJC Scopus subject areas

  • Medicine(all)

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Olsen, S. J., Chang, H. L., Cheung, T. Y. Y., Tang, A. F. Y., Fisk, T. L., Ooi, S. P. L., ... Dowell, S. F. (2003). Transmission of the Severe Acute Respiratory Syndrome on Aircraft. New England Journal of Medicine, 349(25), 2416-2422. https://doi.org/10.1056/NEJMoa031349

Transmission of the Severe Acute Respiratory Syndrome on Aircraft. / Olsen, Sonja J.; Chang, Hsiao Ling; Cheung, Terence Yung Yan; Tang, Antony Fai Yu; Fisk, Tamara L.; Ooi, Steven Peng Lim; Kuo, Hung Wei; Jiang, Donald Dah Shyong; Chen, Kow Tong; Lando, Jim; Hsu, Kwo Hsiung; Chen, Tzay Jinn; Dowell, Scott F.

In: New England Journal of Medicine, Vol. 349, No. 25, 18.12.2003, p. 2416-2422.

Research output: Contribution to journalArticle

Olsen, SJ, Chang, HL, Cheung, TYY, Tang, AFY, Fisk, TL, Ooi, SPL, Kuo, HW, Jiang, DDS, Chen, KT, Lando, J, Hsu, KH, Chen, TJ & Dowell, SF 2003, 'Transmission of the Severe Acute Respiratory Syndrome on Aircraft', New England Journal of Medicine, vol. 349, no. 25, pp. 2416-2422. https://doi.org/10.1056/NEJMoa031349
Olsen SJ, Chang HL, Cheung TYY, Tang AFY, Fisk TL, Ooi SPL et al. Transmission of the Severe Acute Respiratory Syndrome on Aircraft. New England Journal of Medicine. 2003 Dec 18;349(25):2416-2422. https://doi.org/10.1056/NEJMoa031349
Olsen, Sonja J. ; Chang, Hsiao Ling ; Cheung, Terence Yung Yan ; Tang, Antony Fai Yu ; Fisk, Tamara L. ; Ooi, Steven Peng Lim ; Kuo, Hung Wei ; Jiang, Donald Dah Shyong ; Chen, Kow Tong ; Lando, Jim ; Hsu, Kwo Hsiung ; Chen, Tzay Jinn ; Dowell, Scott F. / Transmission of the Severe Acute Respiratory Syndrome on Aircraft. In: New England Journal of Medicine. 2003 ; Vol. 349, No. 25. pp. 2416-2422.
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abstract = "BACKGROUND: The severe acute respiratory syndrome (SARS) spread rapidly around the world, largely because persons infected with the SARS-associated coronavirus (SARS-CoV) traveled on aircraft to distant cities. Although many infected persons traveled on commercial aircraft, the risk, if any, of in-flight transmission is unknown. METHODS: We attempted to interview passengers and crew members at least 10 days after they had taken one of three flights that transported a patient or patients with SARS. All index patients met the criteria of the World Health Organization for a probable case of SARS, and index or secondary cases were confirmed to be positive for SARS-COV on reverse-transcriptase polymerase chain reaction or serologic testing. RESULTS: After one flight carrying a symptomatic person and 119 other persons, laboratory-confirmed SARS developed in 16 persons, 2 others were given diagnoses of probable SARS, and 4 were reported to have SARS but could not be interviewed. Among the 22 persons with illness, the mean time from the flight to the onset of symptoms was four days (range, two to eight), and there were no recognized exposures to patients with SARS before or after the flight. Illness in passengers was related to the physical proximity to the index patient, with illness reported in 8 of the 23 persons who were seated in the three rows in front of the index patient, as compared with 10 of the 88 persons who were seated elsewhere (relative risk, 3.1; 95 percent confidence interval, 1.4 to 6.9). In contrast, another flight carrying four symptomatic persons resulted in transmission to at most one other person, and no illness was documented in passengers on the flight that carried a person who had presymptomatic SARS. CONCLUSIONS: Transmission of SARS may occur on an aircraft when infected persons fly during the symptomatic phase of illness. Measures to reduce the risk of transmission are warranted.",
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