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. 2020 Nov-Dec:38:101882.
doi: 10.1016/j.tmaid.2020.101882. Epub 2020 Sep 17.

In-flight transmission of COVID-19 on flights to Greece: An epidemiological analysis

Androula Pavli  1 , Paraskevi Smeti  1 , Sophia Hadjianastasiou  1 , Kalliopi Theodoridou  2 , Athina Spilioti  1 , Kalliopi Papadima  3 , Anastasia Andreopoulou  3 , Kassiani Gkolfinopoulou  4 , Spyros Sapounas  5 , Nikolaos Spanakis  6 , Athanasios Tsakris  6 , Helena C Maltezou  7
Affiliations

In-flight transmission of COVID-19 on flights to Greece: An epidemiological analysis

Androula Pavli et al. Travel Med Infect Dis. 2020 Nov-Dec.

Abstract

Background: The emergence in China in late 2019 and subsequent progression of a pandemic of a respiratory disease named coronavirus disease 2019 (COVID-19) was highly facilitated by international travel. We present 5 cases of probable in-flight transmission in Greece.

Methods: We studied international passengers arriving to or departing from Greece from February 26 through March 9, 2020. Contact tracing extended up to 4 days before the onset of symptoms and focused on close contacts. Close contacts were defined as persons sitting within a distance of <2 m for >15 min, including passengers seated two seats around the index case and all crew members and persons who had close contact with the index case.

Results: We investigated 18 international flights with 2224 passengers and 110 crew members. Main countries of departure included Northern Italy, Israel and the United Kingdom. In accordance with the national surveillance investigation, in these flights there were 21 index cases and 891 contact traced cases. Six index cases were symptomatic during the flight. Of the 891 contact traced cases, 4 passengers and 1 crew member developed laboratory-confirmed infection (3 with COVID-19 and 2 with asymptomatic infection); they travelled on the same flight with two COVID-19 cases.

Conclusions: Air travel has played a central role in the progression of the COVID-19 pandemic. However, there are scarce data about in-flight transmission. Our extensive investigation showed five cases of probable in-flight transmission. Efforts should be placed in order to ensure the prompt implementation of appropriate infection control measures on board.

Keywords: Aircraft; COVID-19; Contact tracing; In-flight; Pandemic; SARS-CoV-2; Transmission; Travel.

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Conflict of interest statement

All authors declare no competing interests.

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