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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

Airplanes and Airports—A Hub for Travel and Germs

SEP 24, 2018 | SASKIA V. POPESCU
Most people have a general sense that air travel tends to involve exposure to germs. Whether it’s through the thousands of people we will come into contact with, the sick person next to us on the plane, or the dirty surfaces, many of us get a sense of unease knowing there is a real chance we may arrive at our destination with a microscopic companion.

The recent quarantine of several flights, including the flight from Dubai which landed at John F. Kennedy International Airport with 100 sick passengers, was another reminder that air travel is not without the risks. The majority of sick passengers on that flight were found to be experiencing influenza and other common respiratory illnesses. One of the reasons for the heightened response to the illnesses was the flight’s origin—Dubai—which likely saw increased travelers following the recent Hajj pilgrimage to Mecca, in Saudi Arabia. Any large gathering can increase the risk of disease transmission, but, the risk is amplified during the pilgrimage because Saudi Arabia has continued to experience outbreaks of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) since it was first identified there in 2012. One can, therefore, understand the heightened concern over a large group of passengers returning from the country all falling ill. The simple truth is that when traveling, there are some things you can control and some you cannot.

The good news is that you can try to at least reduce the risk of infection through your seating practices and trying to avoid sick people. On a transcontinental flight, investigators have found that if a person is sitting within 1 row of a sick person, they are more likely to catch their illness. Meaning that if you are seated in the same row, or directly in front of or behind, an ill person (in the aisle seat), the odds are not in your favor. If you can move outside that area or pick a window seat should you be in that 3-row zone, you can decrease the odds of getting sick.

Although in-flight movements were found to have little effect on increasing disease transmission, to have the best chance of avoiding illness an individual should stay in a window seat for the duration of the flight. Those concerned about more threatening, but less likely illnesses, such as pneumonic plague or severe acute respiratory syndrome (SARS), can breathe a little easier (pun intended). According to Nereyda Sevilla, PhD, a civilian aerospace physiologist for the Medical Research and Acquisitions Division in the Office of the Air Force Surgeon General, “I’ve found the airplane is not what’s going to get you infected with disease. You’re more likely to get sick from waiting in the boarding area next to someone with a cold.”

Much of the research on the transmission of illnesses on airplanes have focused on infections transmitted through coughing, but what about through contact with contaminated objects and surfaces? Recently, investigators on a new study studied the high-touch surfaces in airports as a source for transmitting influenza A and B viruses, respiratory syncytial virus, adenovirus, rhinovirus, and coronavirus. Interestingly (or perhaps not, for those of us who travel a lot), the investigators found that the hand-carried luggage trays at security check areas had the most viral burden; 4 of the 8 samples from the trays were positive for contamination. Of the 90 surface samples collected, 9 had at least 1 respiratory virus detected on it. Other samples included a plastic dog toy in a children’s playground (2 of the 3 samples tested positive), and stair handrails (1 of the 7 samples tested positive).

Of the 10 respiratory viruses the team found through sampling, 40% were rhinovirus, 30% were coronavirus, 20% were adenovirus, and 10% were influenza A. 

With all this information in mind, as the fall holidays approach and airline travel becomes busier, there are a few things we all can do to avoid the onslaught of infectious disease: Get vaccinated, wash our hands (and carry around some hand sanitizer!), stay home if we’re sick, book that window seat, and if we can, wipe down our high-touch areas with some disinfecting wipes.

And, remember, airplanes might be hubs for respiratory viruses, but let’s not forget what lurks on sea cruises…Bon voyage!
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