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Does 2x2 airplane passenger contact tracing for infectious respiratory pathogens work? A systematic review of the evidence
We critically appraised the literature regarding in-flight transmission of a range of respiratory infections to provide an evidence base for public health policies for contact tracing passengers, given the limited pathogen-specific data for SARS-CoV-2 currently available. Using PubMed, Web of Scienc...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894495/ https://www.ncbi.nlm.nih.gov/pubmed/36730309 http://dx.doi.org/10.1371/journal.pone.0264294 |
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author | Rafferty, Anna C. Bofkin, Kelly Hughes, Whitney Souter, Sara Hosegood, Ian Hall, Robyn N. Furuya-Kanamori, Luis Liu, Bette Drane, Michael Regan, Toby Halder, Molly Kelaher, Catherine Kirk, Martyn D. |
author_facet | Rafferty, Anna C. Bofkin, Kelly Hughes, Whitney Souter, Sara Hosegood, Ian Hall, Robyn N. Furuya-Kanamori, Luis Liu, Bette Drane, Michael Regan, Toby Halder, Molly Kelaher, Catherine Kirk, Martyn D. |
author_sort | Rafferty, Anna C. |
collection | PubMed |
description | We critically appraised the literature regarding in-flight transmission of a range of respiratory infections to provide an evidence base for public health policies for contact tracing passengers, given the limited pathogen-specific data for SARS-CoV-2 currently available. Using PubMed, Web of Science, and other databases including preprints, we systematically reviewed evidence of in-flight transmission of infectious respiratory illnesses. A meta-analysis was conducted where total numbers of persons on board a specific flight was known, to calculate a pooled Attack Rate (AR) for a range of pathogens. The quality of the evidence provided was assessed using a bias assessment tool developed for in-flight transmission investigations of influenza which was modelled on the PRISMA statement and the Newcastle-Ottawa scale. We identified 103 publications detailing 165 flight investigations. Overall, 43.7% (72/165) of investigations provided evidence for in-flight transmission. H1N1 influenza A virus had the highest reported pooled attack rate per 100 persons (AR = 1.17), followed by SARS-CoV-2 (AR = 0.54) and SARS-CoV (AR = 0.32), Mycobacterium tuberculosis (TB, AR = 0.25), and measles virus (AR = 0.09). There was high heterogeneity in estimates between studies, except for TB. Of the 72 investigations that provided evidence for in-flight transmission, 27 investigations were assessed as having a high level of evidence, 23 as medium, and 22 as low. One third of the investigations that reported on proximity of cases showed transmission occurring beyond the 2x2 seating area. We suggest that for emerging pathogens, in the absence of pathogen-specific evidence, the 2x2 system should not be used for contact tracing. Instead, alternate contact tracing protocols and close contact definitions for enclosed areas, such as the same cabin on an aircraft or other forms of transport, should be considered as part of a whole of journey approach. |
format | Online Article Text |
id | pubmed-9894495 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-98944952023-02-03 Does 2x2 airplane passenger contact tracing for infectious respiratory pathogens work? A systematic review of the evidence Rafferty, Anna C. Bofkin, Kelly Hughes, Whitney Souter, Sara Hosegood, Ian Hall, Robyn N. Furuya-Kanamori, Luis Liu, Bette Drane, Michael Regan, Toby Halder, Molly Kelaher, Catherine Kirk, Martyn D. PLoS One Research Article We critically appraised the literature regarding in-flight transmission of a range of respiratory infections to provide an evidence base for public health policies for contact tracing passengers, given the limited pathogen-specific data for SARS-CoV-2 currently available. Using PubMed, Web of Science, and other databases including preprints, we systematically reviewed evidence of in-flight transmission of infectious respiratory illnesses. A meta-analysis was conducted where total numbers of persons on board a specific flight was known, to calculate a pooled Attack Rate (AR) for a range of pathogens. The quality of the evidence provided was assessed using a bias assessment tool developed for in-flight transmission investigations of influenza which was modelled on the PRISMA statement and the Newcastle-Ottawa scale. We identified 103 publications detailing 165 flight investigations. Overall, 43.7% (72/165) of investigations provided evidence for in-flight transmission. H1N1 influenza A virus had the highest reported pooled attack rate per 100 persons (AR = 1.17), followed by SARS-CoV-2 (AR = 0.54) and SARS-CoV (AR = 0.32), Mycobacterium tuberculosis (TB, AR = 0.25), and measles virus (AR = 0.09). There was high heterogeneity in estimates between studies, except for TB. Of the 72 investigations that provided evidence for in-flight transmission, 27 investigations were assessed as having a high level of evidence, 23 as medium, and 22 as low. One third of the investigations that reported on proximity of cases showed transmission occurring beyond the 2x2 seating area. We suggest that for emerging pathogens, in the absence of pathogen-specific evidence, the 2x2 system should not be used for contact tracing. Instead, alternate contact tracing protocols and close contact definitions for enclosed areas, such as the same cabin on an aircraft or other forms of transport, should be considered as part of a whole of journey approach. Public Library of Science 2023-02-02 /pmc/articles/PMC9894495/ /pubmed/36730309 http://dx.doi.org/10.1371/journal.pone.0264294 Text en © 2023 Rafferty et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Rafferty, Anna C. Bofkin, Kelly Hughes, Whitney Souter, Sara Hosegood, Ian Hall, Robyn N. Furuya-Kanamori, Luis Liu, Bette Drane, Michael Regan, Toby Halder, Molly Kelaher, Catherine Kirk, Martyn D. Does 2x2 airplane passenger contact tracing for infectious respiratory pathogens work? A systematic review of the evidence |
title | Does 2x2 airplane passenger contact tracing for infectious respiratory pathogens work? A systematic review of the evidence |
title_full | Does 2x2 airplane passenger contact tracing for infectious respiratory pathogens work? A systematic review of the evidence |
title_fullStr | Does 2x2 airplane passenger contact tracing for infectious respiratory pathogens work? A systematic review of the evidence |
title_full_unstemmed | Does 2x2 airplane passenger contact tracing for infectious respiratory pathogens work? A systematic review of the evidence |
title_short | Does 2x2 airplane passenger contact tracing for infectious respiratory pathogens work? A systematic review of the evidence |
title_sort | does 2x2 airplane passenger contact tracing for infectious respiratory pathogens work? a systematic review of the evidence |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894495/ https://www.ncbi.nlm.nih.gov/pubmed/36730309 http://dx.doi.org/10.1371/journal.pone.0264294 |
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