Journal Article

Likely Transmission of Norovirus on an Airplane, October 2008

Hannah L. Kirking, Jennifer Cortes, Sherry Burrer, Aron J. Hall, Nicole J. Cohen, Harvey Lipman, Curi Kim, Elizabeth R. Daly and Daniel B. Fishbein

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 9, pages 1216-1221
Published in print May 2010 | ISSN: 1058-4838
Published online May 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/651597
Likely Transmission of Norovirus on an Airplane, October 2008

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Background. On 8 October 2008, members of a tour group experienced diarrhea and vomiting throughout an airplane flight from Boston, Massachusetts, to Los Angeles, California, resulting in an emergency diversion 3 h after takeoff. An investigation was conducted to determine the cause of the outbreak, assess whether transmission occurred on the airplane, and describe risk factors for transmission.

Methods. Passengers and crew were contacted to obtain information about demographics, symptoms, locations on the airplane, and possible risk factors for transmission. Case patients were defined as passengers with vomiting or diarrhea (⩾ loose stools in 24 h) and were asked to submit stool samples for norovirus testing by real-time reverse-transcription polymerase chain reaction.

Results. Thirty-six (88%) of 41 tour group members were interviewed, and 15 (41%) met the case definition (peak date of illness onset, 8 October 2008). Of 106 passengers who were not tour group members, 85 (80%) were interviewed, and 7 (8%) met the case definition after the flight (peak date of illness onset, 10 October 2008). Multivariate logistic regression analysis showed that sitting in an aisle seat (adjusted relative risk, 11.0; 95% confidence interval, 1.4–84.9) and sitting near any tour group member (adjusted relative risk, 7.5; 95% confidence interval, 1.7–33.6) were associated with the development of illness. Norovirus genotype II was detected by reversetranscription polymerase chain reaction in stool samples from case patients in both groups.

Conclusions. Despite the short duration, transmission of norovirus likely occurred during the flight.

Journal Article.  4049 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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