role of aircraft in the international transmission of disease, The

Journal of Multicultural Nursing & Health, Winter 2000 by Neff-Smith, Martha, Spencer, Gale A, Williams, Richard S, O'Donnell, Charles R, Riley-Eddins, Essie A

Lassa fever, a highly infectious African hemorrhagic fever with a 30-50% fatality rate among hospitalized patients, is representative of the hazards of rapid international transportation. Endemic Lassa fever is a zoonotic disease, maintained in a wild rodent reservoir. Transmission can occur, however, though fomites. Several pre-clinical cases of Lassa fever have been transported by air to the United States, and several secondary cases and at least one death have occurred. This clearly demonstrates the clear potential of air transportation to spread exotic, deadly and difficult to diagnose diseases among susceptible populations.

Perhaps the most dramatic example of the role of aircraft in the transmission of disease was described by Shilts (1987) in And the Band Played On. A male flight attendant infected with the Human Immunodeficiency Virus) thought to have served as the index case of AIDS in the United States. This flight attendant, moving rapidly from city to city, spread HIV through unprotected sexual contact with multiple partners. These individuals then served as the foci of infection in their respective geographic areas, ultimately giving rise to the AIDS pandemic. While it is true that the spread of AIDS on this continent was inevitable, it is sobering to think that that present pandemic may have been greatly accelerated by a single individual with un-limited access to air travel.

Vector-borne diseases and pests have also been transported by air to new populations and locales. Several malaria outbreaks over the past few decades (one death in 1978, a minor outbreak in Fresno, California in the 1960's and an outbreak among Campfire Girls in 1952) have been linked to infected individuals returning to the United States from Asia. Explosive outbreaks of dengue, Japanese B encephalitis and malaria on `Guam have been linked to air travel. Infestations of the Khapra beetle, a grain pest indigenous to the Middle East, noted in United States burlap bag manufacturing facilities in the 1980's.

During the first half of 1995, 48 million passengers traveled between the Unites States and the rest of the world (US Department of Transportation). This represented a 6% increase over the first half of 1994. The close proximity of passengers combined with the risk of person to person transmission of tuberculosis has been the point of discussion and research in recent years. During the period from 1993 to 1995 the Centers for Disease Control and state health departments investigated six instances in which persons with TB traveled on commercial aircraft while infectious with mycobacterium tuberculosis. In two cases the index cases (travelers) were aware of their TB at the time of travel. The airlines were not aware of the problem in any of the six cases. The CDC concluded that TB had been transmitted in two of the six exposures (MMWR, 1995).

The potential exposure of large numbers of persons over very short periods of time is a cause for concern among public health professionals around the world. The emergence of drug resistant strains, has created more apprehension.