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Public Health

Assessment of SARS-CoV-2 Transmission on an International Flight and Among a Tourist Group

Educational Objective
To understand the transmission rate of COVID-19 on an international flight and among a tourist group

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JAMA Network Open

Published Online: August 18, 2020

Research Letter

Article Information and Disclosures

Sebastian Hoehl, MD¹;

Niko Kohmer, MD¹;

Sandra Westhaus, PhD¹;

Jürgen Graf, MD²;

Udo Goetsch, MD³;

Sandra Ciesek, MD^1,4,5

Author Affiliations

¹Institute for Medical Virology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
²University Hospital Frankfurt am Main, Frankfurt am Main, Germany
³Health Protection Authority, City of Frankfurt, Frankfurt am Main, Germany
⁴Fraunhofer Institute for Molecular Biology and Applied Ecology, Branch Translational Medicine und Pharmacology, Frankfurt, Frankfurt am Main, Germany
⁵German Centre for Infection Research, Deutsches Zentrum für Infektionsforschung, External Partner Site Frankfurt, Frankfurt am Main, Germany

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This case series assessed a commercial airline flight from Tel Aviv, Israel, to Frankfurt, Germany, that occurred on March 9th, 2020. Among 102 passengers on a Boeing 737-900 aircraft were 24 members of a tourist group. Starting 7 days earlier, the group had contact with a hotel manager who later received a diagnosis of coronavirus disease 2019 (COVID-19). No member of the group had received a diagnosis of COVID-19 before the flight, and no measures to prevent transmission (eg, wearing of masks) had been applied. The flight duration was 4 hours 40 minutes.

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Article Information

Accepted for Publication: July 14, 2020.

Published: August 18, 2020. doi:10.1001/jamanetworkopen.2020.18044

Correction: This article was corrected on September 16, 2020, to fix an error in the affiliations.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Hoehl S et al. JAMA Network Open.

Corresponding Author: Sandra Ciesek, MD, Institute for Medical Virology, University Hospital, Goethe University Frankfurt am Main, Germany Paul-Ehrlich-Straße 40, 60596 Frankfurt am Main, Germany (sandra.ciesek@kgu.de).

Author Contributions: Drs Ciesek and Hoehl had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Hoehl, Karaca, Graf, Ciesek.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Hoehl, Karaca, Kohmer.

Critical revision of the manuscript for important intellectual content: All authors.

Obtained funding: Ciesek.

Administrative, technical, or material support: Hoehl, Kohmer, Graf, Götsch.

Supervision: Hoehl, Graf, Ciesek.

Conflict of Interest Disclosures: None reported.

Additional Contributions: Pia Behrens, MD, and Petra Tiarks-Jungk, MD (Health Protection Authority, City of Frankfurt, Frankfurt am Main, Germany), conducted medical evaluations at the destination airport. Holger Czerwonka, MD, and Michael Sroka, MD, of Frankfurt Airport Medical Services and René Gottschalk, MD, Chief Medical Officer of the Public Health Authority, City of Frankfurt, supported the study and provided advice for the manuscript; Bernd Jilka (PIXELGYM) provided graphical support for Figure 1; and Maria Vehreschild, MD, Department of Infectious Diseases, University Hospital, Goethe University Frankfurt am Main, helped with critical reading of the manuscript. None of these individuals received compensation for their help.

References

Hertzberg VS , Weiss H , Elon L , Si W , Norris SL ; FlyHealthy Research Team. Behaviors, movements, and transmission of droplet-mediated respiratory diseases during transcontinental airline flights. Proc Natl Acad Sci U S A. 2018;115(14):3623-3627. doi:10.1073/pnas.1711611115 PubMed Google Scholar Crossref

Leitmeyer K , Adlhoch C . Review article: influenza transmission on aircraft: a systematic literature review. Epidemiology. 2016;27(5):743-751. doi:10.1097/EDE.0000000000000438 PubMed Google Scholar Crossref

Olsen SJ , Chang HL , Cheung TY , et al. Transmission of the severe acute respiratory syndrome on aircraft. N Engl J Med. 2003;349(25):2416-2422. doi:10.1056/NEJMoa031349 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.