Study details likely SARS-CoV-2 transmission on international flight
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Two people on an international flight from Israel to Germany likely acquired SARS-CoV-2 from fellow passengers who had unknowingly been in contact with an infected hotel manager, according to a study.
Although the rate of transmission inside the plane was lower than expected, it shows that the coronavirus can spread between plane passengers when no preventive measures are in place, said Sandra Ciesek, MD, director of the Institute for Medical Virology at the University Hospital Frankfurt.
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The flight from Tel Aviv to Frankfurt occurred on March 9 with 102 passengers on board, including 24 members of a tourist group who had contact with a hotel manager for 1 week who later was diagnosed with COVID-19.
According to the study, Ciesek and colleagues tested throat swab specimens and interviewed all passengers 4 to 5 weeks after the flight by phone, including asking passengers if they had contact with a person who was positive for COVID-19.
The researchers determined that seven of 24 tourist group travelers on the flight were positive for SARS-CoV-2 four were symptomatic on the flight, whereas two were presymptomatic and one was asymptomatic.
Of the remaining 78 passengers, 71 who had been exposed to the group on the flight completed the study interview and serum samples were collected from 13 of these individuals 6 to 9 weeks after the flight. According to the study, one reported testing positive by PCR 4 days after the flight although this passenger did not recall having symptoms.
The study also revealed that seven other passengers reported having symptoms suggestive of COVID-19 within 14 days after the flight. The researchers obtained serum samples from six other symptomatic and five asymptomatic passengers 6 to 9 weeks after the flight all were negative, except one who had a borderline result on the SARS-CoV-2 immunoglobulin G test but had a negative result on the plaque reduction neutralization test.
The researchers said both passengers who were likely infected on board were seated within two rows of an index case. Past research has shown that sitting within two seats or in the rows directly in front of or behind an infected airline passenger can greatly increase the risk for infection.
The airflow in the cabin from the ceiling to the floor and from the front to the rear may have been associated with a reduced transmission rate, the authors wrote.
According to Ciesek, none of the passengers in the study wore masks and the rate of transmission may have been reduced had HEPA filters been applied to the airplane cabin, although she says it should be investigated further if these filters can be applied more widely in other settings to reduce transmission.
“There have been few reported cases of in-air transmission on an airplane, but it may occur when no measures to reduce prevention are applied,” Ciesek concluded. “This is an important aspect of air travel during the pandemic. The rate may have been reduced by the application of HEPA filters it should be explored whether these filters can be applied in other settings to reduce transmission.”
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