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Volume 19, Number 9—September 2013

Research

Protection by Face Masks against Influenza A(H1N1)pdm09 Virus on Trans-Pacific Passenger Aircraft, 2009

Lijie Zhang1, Zhibin Peng1, Jianming Ou1, Guang Zeng1, Robert E. Fontaine, Mingbin Liu, Fuqiang Cui, Rongtao Hong, Hang Zhou, Yang Huai, Shuk-Kwan Chuang, Yiu-Hong Leung, Yunxia Feng, Yuan Luo, Tao Shen, Bao-Ping Zhu, Marc-Alain Widdowson, and Hongjie YuComments to Author 
Author affiliations: Chinese Center for Disease Control and Prevention, Beijing, China (L. Zhang, Z. Peng, G. Zeng, M. Liu, F. Cui, H. Zhou, Y. Feng, Y. Luo, T. Shen, B.-P. Zhu, H. Yu); Fujian Center for Disease Control and Prevention, Fuzhou, China (J. Ou, R. Hong); Nanchang Center for Disease Control and Prevention, Nanchang, China (M. Liu); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R. E. Fontaine, M.-A. Widdowson); China–US Collaborative Program on Emerging and Re-emerging Infectious Diseases, Beijing (Y. Huai); Hong Kong Department of Health, Hong Kong, China (S.-K. Chuang, Y.-H. Leung)

Main Article

Table

Case–control analysis of potential risk or protective factors for 9 case-passengers infected with influenza A(H1N1)pdm09 virus and 32 control-passengers on a flight from New York, New York, to Hong Kong, China, May 2009*

Risk or protective factor No response, no. (%)† Response, no. (%) OR (95% CI)‡ 2-tailed 
p value‡
Case
Case
 Control
 Case
 Control
Age, y Age, y
<20 0 0 4 (44) 4 (12) <20 0
20–40 0 0 4 (44) 15 (47) 20–40 0
>40 0 0 1 (11) 13 (41) >40 0
Male sex 0 0 5 (56) 15 (47) Male sex 0
Chinese ethnicity 0 0 8 (89) 32 (100) Chinese ethnicity 0
Flight from New York to Vancouver Flight from New York to Vancouver
Wearing mask 0 0 1 (11) 16 (57) Wearing mask 0
Using lavatory 3 0 3 (11) 2 (22) 7 (28) Using lavatory 3 0
Using lavatory 5 1 (11) 3 (11) 2 (25) 4 (16) Using lavatory 5 1 (11)
Using lavatory 3 or 5 1 (11) 1 (3.6) 3 (38) 11 (41) Using lavatory 3 or 5 1 (11)
Using lavatory 3, 4, 5, or 6 0 1 (3.6) 6 (67) 14 (52) Using lavatory 3, 4, 5, or 6 0
Flight from Vancouver to Hong Kong Flight from Vancouver to Hong Kong
Wearing mask 0 0 0 15 (47) Wearing mask 0
Using lavatory 3 0 2 (6) 5 (56) 7 (23) Using lavatory 3 0
Using lavatory 5 1 (13) 2 (6) 1 (13) 5 (17) Using lavatory 5 1 (13)
Using lavatory 3 or 5 1 (13) 0 5 (63) 12 (38) Using lavatory 3 or 5 1 (13)
Using lavatory 3, 4, 5, or 6 0 0 7 (78) 20 (63) Using lavatory 3, 4, 5, or 6 0
Flight from New York to Hong Kong Flight from New York to Hong Kong
Wearing mask 0 0 0 15 (47) Wearing mask 0
Talking with other passengers 0 0 2 (22) 6 (19) Talking with other passengers 0
Moving around airplane 0 0 1 (11) 3 (9.4) Moving around airplane 0
Contact with patients with ILI 0 0 0 0 Contact with patients with ILI 0
Hand sanitation¶ Hand sanitation¶
Washing hands when using lavatory 0 0 9 (100) 32 (100) Washing hands when using lavatory 0
Cleaning hands before eating 0 0 8 (89) 29 (91) Cleaning hands before eating 0
Among 9 case- and 17 control-passengers who did not wear masks during flight from Vancouver to Hong Kong
Using lavatory 3 0 1 (6) 5 (56) 6 (38) Using lavatory 3 0
Using lavatory 3 or 5 1 (13) 0 5 (63) 9 (53) Using lavatory 3 or 5 1 (13)
Using lavatory 3, 4, 5, or 6 0 0 7 (78) 13 (76) Using lavatory 3, 4, 5, or 6 0

*Of the 32 control-passengers on the flight from New York to Hong Kong, 28 boarded in New York and 4 boarded in Vancouver, British Columbia, Canada. OR, odds ratio; NA, not applicable; ILI, influenza-like illness; NE, not estimated.
†No. case-passengers or control-passengers who did not answer the question.
‡By Fisher Exact test and StatXact 8 (15).
§Difference among 3 age groups.
¶Always washed hands when using lavatory and always used wet towel before eating.

Main Article

References
  1. Centers for Disease Control and Prevention. Swine influenza A (H1N1) infection in two children—Southern California, March–April 2009. MMWR Morb Mortal Wkly Rep. 2009;58:400–2 .PubMedGoogle Scholar
  2. World Health organization. Pandemic (H1N1) 2009 update 58 [cited 2012 Mar 14]. http://www.who.int/csr/don/2009_07_06/en/index.html
  3. General Administration of Quality Supervision, Inspection, and Quarantine of the People’s Republic of China. Notice on completion of entry-exit health card at land and water borders, 2009 [cited 2012 May 10]. http://www.aqsiq.gov.cn/zjxw/zjxw/zjftpxw/200905/t20090504_113171.htm
  4. General Administration of Quality, Supervision, and Quarantine of the People’s Republic of China. Emergency notice on prevention against the importation of human infection with swine influenza, 2009 [cited 2012 May 10]. http://www.aqsiq.gov.cn/zwgk/tzgg/200904/t20090425_112329.htm
  5. World Health Organization. CDC protocol of realtime RT-PCR for influenza A (H1N1) [cited 2012 Mar 14]. http://www.who.int/csr/resources/publications/swineflu/realtimeptpcr/en/
  6. Bin  C, Xingwang  L, Yuelong  S, Nan  J, Chen  S, Xiayuan  X, Clinical and epidemiologic characteristics of 3 early cases of influenza A pandemic (H1N1) 2009 virus infection, People’s Republic of China, 2009. Emerg Infect Dis. 2009;15:1418–22. DOIPubMedGoogle Scholar
  7. Chinese Ministry of Health. Technical guidelines for the prevention and control of pH1N1 [in Chinese]. Beijing: Chinese Ministry of Health; 2009.
  8. Transmission dynamics and impact of pandemic influenza A (H1N1) 2009 virus. Wkly Epidemiol Rec. 2009;84:481–4 .PubMedGoogle Scholar
  9. White  LF, Wallinga  J, Finelli  L, Reed  C, Riley  S, Lipsitch  M, Estimation of the reproductive number and the serial interval in early phase of the 2009 influenza A/H1N1 pandemic in the USA. Influenza Other Respi Viruses. 2009;3:267–76. DOIPubMedGoogle Scholar
  10. Odaira  F, Takahashi  H, Toyokawa  T, Tsuchihashi  Y, Kodama  T, Yahata  Y, Assessment of secondary attack rate and effectiveness of antiviral prophylaxis among household contacts in an influenza A(H1N1)v outbreak in Kobe, Japan, May–June 2009. Euro Surveill. 2009;14:19320 .PubMedGoogle Scholar
  11. Cauchemez  S, Donnelly  CA, Reed  C, Ghani  AC, Fraser  C, Kent  CK, Household transmission of 2009 pandemic influenza A (H1N1) virus in the United States. N Engl J Med. 2009;361:2619–27. DOIPubMedGoogle Scholar
  12. Fontaine  RE, Goodman  RA. Describing the findings: descriptive epidemiology. In: Gregg MB, editor. Field epidemiology, 3rd ed. New York: Oxford University Press; 2008. p. 156–98.
  13. Centre for Health Protection. Hong Kong. CHP molecular diagnostic protocols for the detection of human swine influenza type A (subtype H1) revision 2, 2009 [cited 2011 Jun 26]. http://www.chp.gov.hk/files/pdf/chp_protocols_for_the_detection_of_human_swine_influenza.pdf
  14. Centers for Disease Control and Prevention. H1N1 flu: interim guidance on specimen collection, processing, and testing for patients with suspected novel influenza A (H1N1) (swine flu) virus infection [cited 2012 Jun 12]. http://www.cdc.gov/h1n1flu/specimencollection.htm
  15. Mehta  C, Patel  N. StatXact 8: Software for exact nonparametric inference. Cambridge (MA): Cytel Software Corporation; 2007.
  16. Reed  C, Angulo  FJ, Swerdlow  DL, Lipsitch  M, Meltzer  MI, Jernigan  D, Estimates of the prevalence of pandemic (H1N1) 2009, United States, April–July 2009. Emerg Infect Dis. 2009;15:2004–7. DOIPubMedGoogle Scholar
  17. Khan  K, Arino  J, Hu  W, Raposo  P, Sears  J, Calderon  F, Spread of a novel influenza A (H1N1) virus via global airline transportation. N Engl J Med. 2009;361:212–4. DOIPubMedGoogle Scholar
  18. Mangili  A, Gendreau  MA. Transmission of infectious diseases during commercial air travel. Lancet. 2005;365:989–96 . DOIPubMedGoogle Scholar
  19. Foxwell  AR, Roberts  L, Lokuge  K, Kelly  PM. Transmission of influenza on international flights, May 2009. Emerg Infect Dis. 2011;17:1188–94. DOIPubMedGoogle Scholar
  20. Baker  MG, Thornley  CN, Mills  C, Roberts  S, Perera  S, Peters  J, Transmission of pandemic A/H1N1 2009 influenza on passenger aircraft: retrospective cohort study. BMJ. 2010;340:c2424. DOIPubMedGoogle Scholar
  21. Marsden  AG. Influenza outbreak related to air travel. Med J Aust. 2003;179:172–3 .PubMedGoogle Scholar
  22. Gupta  JK, Lin  C-H, Chen  Q. Inhalation of expiratory droplets in aircraft cabins. Indoor Air. 2011;21:341–50. DOIPubMedGoogle Scholar
  23. Pestre  V, Morel  B, Encrenaz  N, Brunon  A, Lucht  F, Pozzetto  B, Transmission by super-spreading event of pandemic A/H1N1 2009 influenza during road and train travel. Scand J Infect Dis. 2012;44:225–7. DOIPubMedGoogle Scholar
  24. Moser  MR, Bender  TR, Margolis  HS, Noble  GR, Kendal  AP, Ritter  DG. An outbreak of influenza aboard a commercial airliner. Am J Epidemiol. 1979;110:1–6 .PubMedGoogle Scholar
  25. Aiello  AE, Perez  V, Coulborn  RM, Davis  BM, Uddin  M, Monto  AS. Facemasks, hand hygiene, and influenza among young adults: a randomized intervention trial. PLoS ONE. 2012;7:e29744. DOIPubMedGoogle Scholar
  26. MacIntyre  CR, Cauchemez  S, Dwyer  DE, Seale  H, Cheung  P, Browne  G, Face mask use and control of respiratory virus transmission in households. Emerg Infect Dis. 2009;15:233–41. DOIPubMedGoogle Scholar
  27. Yang  P, Seale  H, MacIntyre  CR, Zhang  H, Zhang  Z, Zhang  Y, Mask-wearing and respiratory infection in healthcare workers in Beijing, China. Braz J Infect Dis. 2011;15:102–8 .PubMedGoogle Scholar
  28. Cowling  BJ, Fung  RO, Cheng  CK, Fang  VJ, Chan  KH, Seto  WH, Preliminary findings of a randomized trial of non-pharmaceutical interventions to prevent influenza transmission in households. PLoS ONE. 2008;3:e2101. DOIPubMedGoogle Scholar
  29. Cowling  BJ, Chan  K-H, Fang  VJ, Cheng  CK, Fung  RO, Wai  W, Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. Ann Intern Med. 2009;151:437–46. DOIPubMedGoogle Scholar
  30. Davies  KJ, Herbert  AM, Westmoreland  D, Bagg  J. Seroepidemiological study of respiratory virus infections among dental surgeons. Br Dent J. 1994;176:262–5. DOIPubMedGoogle Scholar
  31. Al-Asmary  S, Al-Shehri  A-S, Abou-Zeid  A, Abdel-Fattah  M, Hifnawy  T, El-Said  T. Acute respiratory tract infections among Hajj medical mission personnel, Saudi Arabia. Int J Infect Dis. 2007;11:268–72. DOIPubMedGoogle Scholar
  32. Ng  TC, Lee  N, Hui  S-CD, Lai  R, Ip  M. Preventing healthcare workers from acquiring influenza. Infect Control Hosp Epidemiol. 2009;30:292–5. DOIPubMedGoogle Scholar
  33. Loeb  M, Dafoe  N, Mahony  J, John  M, Sarabia  A, Glavin  V, Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. JAMA. 2009;302:1865–71. DOIPubMedGoogle Scholar
  34. Canini  L, Andréoletti  L, Ferrari  P, D’Angelo  R, Blanchon  T, Lemaitre  M, Surgical mask to prevent influenza transmission in households: a cluster randomized trial. PLoS ONE. 2010;5:e13998. DOIPubMedGoogle Scholar
  35. Centers for Disease Control and Prevention. Seasonal influenza (flu): flu activity and surveillance [cited 2012 May 16]. http://www.cdc.gov/flu/weekly/fluactivitysurv.htm
  36. Webster  CH. Airline operating realities and the global spread of infectious diseases. Asia Pac J Public Health. 2010;22:137S–43S. DOIPubMedGoogle Scholar
  37. Bell  DM; World Health Organization Writing Group. Non-pharmaceutical interventions for pandemic influenza, national and community measures. Emerg Infect Dis. 2006;12:88–94 .PubMedGoogle Scholar
  38. Lee  S-A, Grinshpun  SA, Reponen  T. Respiratory performance offered by N95 respirators and surgical masks: human subject evaluation with NaCl aerosol representing bacterial and viral particle size range. Ann Occup Hyg. 2008;52:177–85. DOIPubMedGoogle Scholar
  39. Grinshpun  SA, Haruta  H, Eninger  RM, Reponen  T, McKay  RT, Lee  S-A. Performance of an N95 filtering facepiece particulate respirator and a surgical mask during human breathing: two pathways for particle penetration. J Occup Environ Hyg. 2009;6:593–603. DOIPubMedGoogle Scholar
  40. Gupta  JK, Lin  C-H, Chen  Q. Risk assessment of airborne infectious diseases in aircraft cabins: indoor air, February 7, 2012 [cited 2012 May 13]. http://www.ncbi.nlm.nih.gov/pubmed/22313168

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1These authors contributed equally to this article.

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