The roles of transportation and transportation hubs in the propagation of influenza and coronaviruses: a systematic review

Browne, Annie, Ahmad, Sacha St-Onge, Beck, Charles R. and Nguyen-Van-Tam, Jonathan (2016) The roles of transportation and transportation hubs in the propagation of influenza and coronaviruses: a systematic review. Journal of Travel Medicine, 23 (1). ISSN 1708-8305

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BACKGROUND: Respiratory viruses spread in humans across wide geographical areas in short periods of time, resulting in high levels of morbidity and mortality. We undertook a systematic review to assess the evidence that air, ground and sea mass transportation systems or hubs are associated with propagating influenza and coronaviruses. METHODS: Healthcare databases and sources of grey literature were searched using pre-defined criteria between April and June 2014. Two reviewers screened all identified records against the protocol, undertook risk of bias assessments and extracted data using a piloted form. Results were analysed using a narrative synthesis. RESULTS: Forty-one studies met the eligibility criteria. Risk of bias was high in the observational studies, moderate to high in the reviews and moderate to low in the modelling studies. In-flight influenza transmission was identified substantively on five flights with up to four confirmed and six suspected secondary cases per affected flight. Five studies highlighted the role of air travel in accelerating influenza spread to new areas. Influenza outbreaks aboard cruise ships affect 2-7% of passengers. Influenza transmission events have been observed aboard ground transport vehicles. High heterogeneity between studies and the inability to exclude other sources of infection means that the risk of influenza transmission from an index case to other passengers cannot be accurately quantified. A paucity of evidence was identified describing severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus transmission events associated with transportation systems or hubs. CONCLUSION: Air transportation appears important in accelerating and amplifying influenza propagation. Transmission occurs aboard aeroplanes, at the destination and possibly at airports. Control measures to prevent influenza transmission on cruise ships are needed to reduce morbidity and mortality. There is no recent evidence of sea transport accelerating influenza or coronavirus spread to new areas. Further investigation is required regarding the roles of ground transportation systems and transport hubs in pandemic situations.

Item Type: Article
Keywords: Air Travel Airports Coronavirus Infections/*transmission Humans Influenza, Human/epidemiology/*transmission Middle East Respiratory Syndrome Coronavirus Risk Factors SARS Virus Severe Acute Respiratory Syndrome/*transmission Ships *Transportation Influenza Mers Sars coronavirus systematic review transport hubs transportation
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Epidemiology and Public Health
Identification Number:
Depositing User: Figgens, Sharon
Date Deposited: 26 Oct 2016 09:58
Last Modified: 04 May 2020 17:31

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