Risk and prevention of respiratory infectious disease transmission on aircraft

The risk of transmission of respiratory infectious diseases is relatively low on commercial aircraft; however, disease spread by airborne and droplet transmission is well documented, particularly within several rows of the source patient. Risk of infectious disease is an occupational hazard for members of the aircrew as well as for business travelers, who comprise an estimated 16% of air travelers. State, local, and federal public health authorities play an important role in helping to assure that patients with serious communicable diseases, including infectious TB and SARS, do not travel by air. These measures still do not guarantee that infectious passengers will not board aircraft. Additionally, not all patients with serious communicable diseases are known to public health authorities prior to air travel, including those with pandemic influenza. Persons on many commercial aircraft flights are not able to avoid crowded conditions, including the highest risk 3-6 foot distance from an ill person, often for extended periods of time. A recent modeling-based study estimated the risk of H1N1 transmission could be moderately high in crowded economy class conditions. This presentation will review potential sources of both direct and indirect contact transmission. Prevention strategies will be discussed, with focus on the unique aircraft environment, intervention feasibility, methods of encouraging voluntary cooperation, and consideration of when mandatory control measures could be indicated.