Risk of measles transmission on aeroplanes: Australian experience 2007-2011
Public Health and Ambulatory Care, North Metropolitan Health Service, Perth, WA, Australia. . The Medical journal of Australia
(Impact Factor: 4.09).
04/2013; 198(6):320-3. DOI: 10.5694/mja12.11752
To quantify the risk of transmission of measles associated with infectious people who travelled on aeroplane flights to or within Australia.
Data were obtained from state and territory health authorities on all measles notifications from January 2007 to June 2011 for people who were likely to have been infectious or infected while travelling on aeroplanes in Australia.
Forty-five infectious people travelled on aeroplanes. Twenty secondary infections occurred in people on seven of 49 flights (14%; 95% CI, 6%-29%), comprising 19% (95% CI, 8%-40%) of the 36 international flights and none of 13 (95% CI, 0-28%) domestic flights that carried infectious people. Secondary infections occurred in nine people who were seated within two rows of the index case and in 11 people who were seated outside of two rows. Secondary transmission was more likely to occur with younger index cases (P = 0.025) and when there were multiple infectious people travelling (
Despite secondary measles transmission occurring on 19% of international flights carrying infectious people, risk was not clearly related to seating proximity, and contact tracing was ineffective, especially given delays in diagnosis, notification and accessing flight manifests. We recommend that direct contact tracing to identify susceptible people exposed to people infected with measles on aeroplane flights should not be undertaken routinely, and other strategies should be considered.
Available from: Frank Beard
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Existing travel health guidelines are based on a variety of data with underpinning evidence ranging from high-quality randomized controlled trials to best estimates from expert opinion. For strategic guidance and to set overall priorities, data about average risk are useful. The World Health Organization (WHO) plans to base future editions of “International Travel and Health” on its new “Handbook for Guideline Development.”Methods
Based on a systematic search in PubMed, the existing evidence and quality of data on vaccine-preventable disease (VPD) risks in travelers was examined and essentials of vaccine efficacy were briefly reviewed. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to evaluate the quality of the data.ResultsModerate-quality data to determine the risk of VPD exist on those that are frequently imported, whereas in most others the level of confidence with existing data is low or very low.Conclusions
In order for the WHO to produce graded risk statements in the updated version of “International Travel and Health,” major investment of time plus additional high-quality, generalizable risk data are needed.
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ABSTRACT: Travel volumes are still increasing resulting in a more interconnected world and fostering the spread of infectious diseases. We aimed to evaluate the relevance of travel-related measles, a highly transmissible and vaccine-preventable disease.
Between 2001 and 2013, surveillance and travel-related measles data were systematically reviewed according to the PRISMA guidelines with extraction of relevant articles from Medline, Embase, GoogleScholar and from public health authorities in the Region of the Americas, Europe and Australia.
From a total of 960 records 44 articles were included and they comprised 2128 imported measles cases between 2001 and 2011. The proportion of imported cases in Europe was low at 1-2%, which reflects the situation in a measles-endemic region. In contrast, imported and import-related measles accounted for up to 100% of all cases in regions with interrupted endemic measles transmission. Eleven air-travel related reports described 132 measles index cases leading to 47 secondary cases. Secondary transmission was significantly more likely to occur if the index case was younger or when there were multiple infectious cases on board. Further spread to health care settings was found. Measles cases associated with cruise ship travel or mass gatherings were sporadically observed.
Within both, endemic and non-endemic home countries, pretravel health advice should assess MMR immunity routinely to avoid measles spread by nonimmune travelers. To identify measles spread as well as to increase and sustain high vaccination coverages joint efforts of public health specialists, health care practitioners and travel medicine providers are needed.
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