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Airline Hygiene

      On a recent transatlantic flight, I had the misfortune to be seated next to a passenger who continuously coughed without covering his mouth. Concerned that this individual might have been travelling from an area where he might have acquired a potentially lethal influenza, I spoke with several of the flight attendants and the purser. We supplied this individual with a surgical mask for the duration of the flight. I subsequently solicited a history of his illness and was relieved to hear that it had begun in the US before he had left for a short trip to Europe. Despite this reassuring news, I was still quite concerned from a public health point of view because all of the passengers on this flight were now exposed to what appeared to be a particularly nasty viral upper respiratory infection. During the flight, I had several opportunities to discuss this patient and similar scenarios with a number of the flight attendants and the purser.
      To my surprise, I discovered that the purser and one of the flight attendants had worked previously in health care before beginning their aviation career. I was not surprised to learn that frequent viral upper respiratory infections were common job-related illnesses affecting flight attendants. I also was not surprised by this disclosure because I knew that many individuals flew despite the presence of an upper respiratory infection. Because the air in the cabins of planes flying at high altitude is recirculated, essentially every passenger on a flight with even one individual afflicted by an active upper respiratory infection will be exposed to an infective viral agent.
      Intrigued by my inflight conversation concerning airline health and hygiene, I interrogated PubMed for previous investigations into flight health. I found a number of studies that related directly to my recent experience.
      • Silver M.R.
      Travel bugs.
      • Hatakka M.
      • Björkroth K.J.
      • Asplund K.
      • Mäki-Petäys N.
      • Korkeala H.J.
      Genotypes and enterotoxicity of Staphylococcus aureus isolated from the hands and nasal cavities of flight-catering employees.
      • Kelly M.
      Control of infection in an international airline.
      • Hatakka M.
      • Asplund K.
      The occurrence of Salmonella in airline meals.
      • Hatakka M.
      Salmonella outbreak among railway and airline passengers.
      • Burslem C.D.
      • Kelly M.J.
      • Preston F.S.
      Food poisoning—a major threat to airline operations.

      Wikipedia. Health hazards of air travel. Available at: http://en.wikipedia.org/wiki/Health_hazards_of_air_travel. Accessed February 4, 2014.

      • Gupta J.K.
      • Lin C.H.
      • Chen Q.
      Risk assessment of airborne infectious diseases in aircraft cabins.
      • Zhang L.
      • Peng Z.
      • Ou J.
      • et al.
      Protection by face masks against influenza A(H1N1)pdm09 virus on trans-Pacific passenger aircraft.
      • Dowdall N.P.
      • Evans A.D.
      • Thibeault C.
      Air travel and TB: an airline perspective.
      • Mangili A.
      • Gendreau M.A.
      Transmission of infectious diseases during commercial air travel.
      Others dealt with the possible transmission of gastrointestinal illness related to food consumed during flight. Clearly, this is an area of major public health concern. As one of my infectious disease colleagues once told me: “There are no more regional illnesses; diseases are now all global.”
      During my extended discussions with the flight attendants and the purser, we explored possible policy changes that airlines might introduce to reduce the risk of cross-infecting passengers and staff during commercial flights. We explored simple and inexpensive universal measures that might accomplish this goal and came up with 2 simple measures that might help: 1) Instructing flight attendants in simple and effective preventive hygiene measures to be taken “on board” during flights, and 2) placing pump bottles containing antibacterial and antiviral hand-cleansing agents in the galley kitchens on all airplanes with instructions for frequent hand washing with this antimicrobial fluid.
      Simple measures that could be employed on flights would resemble the same tactics that we use every day in the hospital when visiting patient rooms, for example, supplying surgical masks to anyone who is actively coughing during a flight, and frequent hand washing with soap and water, as well as frequent application of the above-mentioned antimicrobial fluid to the hands of the flight attendants before and after any physical contact with a passenger.
      As always, I appreciate comments concerning my editorials placed on our AJM blog: www.amjmed.org.

      References

        • Silver M.R.
        Travel bugs.
        Am J Med. 2007; 120: 1011
        • Hatakka M.
        • Björkroth K.J.
        • Asplund K.
        • Mäki-Petäys N.
        • Korkeala H.J.
        Genotypes and enterotoxicity of Staphylococcus aureus isolated from the hands and nasal cavities of flight-catering employees.
        J Food Prot. 2000; 63: 1487-1491
        • Kelly M.
        Control of infection in an international airline.
        Occup Med (Lond). 1993; 43: 91-94
        • Hatakka M.
        • Asplund K.
        The occurrence of Salmonella in airline meals.
        Acta Vet Scand. 1993; 34: 391-396
        • Hatakka M.
        Salmonella outbreak among railway and airline passengers.
        Acta Vet Scand. 1992; 33: 253-260
        • Burslem C.D.
        • Kelly M.J.
        • Preston F.S.
        Food poisoning—a major threat to airline operations.
        J Soc Occup Med. 1990; 40 (Erratum in: J Soc Occup Med. 1991;41:95): 97-100
      1. Wikipedia. Health hazards of air travel. Available at: http://en.wikipedia.org/wiki/Health_hazards_of_air_travel. Accessed February 4, 2014.

        • Gupta J.K.
        • Lin C.H.
        • Chen Q.
        Risk assessment of airborne infectious diseases in aircraft cabins.
        Indoor Air. 2012; 22: 388-395
        • Zhang L.
        • Peng Z.
        • Ou J.
        • et al.
        Protection by face masks against influenza A(H1N1)pdm09 virus on trans-Pacific passenger aircraft.
        Emerg Infect Dis. 2013; 19https://doi.org/10.3201/eid1909.121765
        • Dowdall N.P.
        • Evans A.D.
        • Thibeault C.
        Air travel and TB: an airline perspective.
        Travel Med Infect Dis. 2010; 8: 96-103
        • Mangili A.
        • Gendreau M.A.
        Transmission of infectious diseases during commercial air travel.
        Lancet. 2005; 365: 989-996