De Angelis Giulia, Lohmeyer Franziska Michaela, Grossi Adriano, Posteraro Brunella, Sanguinetti Maurizio
Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
BMC Public Health. 2021 Apr 20;21(1):760. doi: 10.1186/s12889-021-10814-9.
Transmission of viral diseases (e.g., influenza A H1N1) via respiratory droplets takes place mainly in confined spaces, including in aircraft during commercial air travel. The adoption of hygiene measures may help to prevent disease spread aboard aircraft. This review summarizes the evidence on hand hygiene and the use of facemasks as viral disease prevention measures in aircraft.
A literature search was performed in the PubMed, Scopus, and Web of Science databases up to 10 June 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. A population, intervention, comparison, outcomes, and study design (PICOS) approach was used to define the review question.
We included four studies published between 2007 and 2020, all targeting influenza virus disease, in the qualitative synthesis. Three studies used mathematical models to simulate single- or multiple-direction flights, and two of them showed that facemask (e.g., N95 respirator) use considerably reduced infection probability. In the third study, hand cleaning by 20 to 60% of people at any time in all airports (including on aircraft) reduced the measure of airports' power to spread the disease across the globe by ~ 24 to 69%. The fourth study was a case-control study designed to trace an influenza outbreak in two flights during the 2009 influenza A H1N1 pandemic. The study showed that none (0%) of nine infected passengers compared to 15 (47%) of 32 healthy control passengers in the aircraft cabin during one of these flights wore a facemask (odds ratio, 0.0; 95% confidence interval, 0.0-0.7). In contrast, both case and control passengers appeared to be equally compliant in self-assessed hand hygiene.
Facemask use combined with hand hygiene may minimize the chance of droplet-transmitted virus spread by air travelers. Thus, it is necessary that hygiene measures become an integral part of standard procedures in commercial air travel.
病毒性疾病（如甲型H1N1流感）通过呼吸道飞沫传播主要发生在密闭空间内，包括商业航空旅行中的飞机上。采取卫生措施可能有助于预防飞机上疾病的传播。本综述总结了关于手部卫生和使用口罩作为飞机上预防病毒性疾病措施的现有证据。
根据系统评价和Meta分析的首选报告项目标准，于2020年6月10日前在PubMed、Scopus和Web of Science数据库中进行文献检索。采用人群、干预措施、对照、结局和研究设计（PICOS）方法来确定综述问题。
在定性综合分析中，我们纳入了2007年至2020年间发表的四项研究，均针对流感病毒疾病。三项研究使用数学模型模拟单向或多向飞行，其中两项研究表明使用口罩（如N95呼吸器）可显著降低感染概率。在第三项研究中，所有机场（包括飞机上）任何时候有20%至60%的人进行手部清洁，可使机场将疾病传播到全球的能力降低约24%至69%。第四项研究是一项病例对照研究，旨在追踪2009年甲型H1N1流感大流行期间两架航班上的流感暴发情况。该研究表明，在其中一架航班的机舱内，9名感染乘客中无人（0%）佩戴口罩，而32名健康对照乘客中有15人（47%）佩戴口罩（比值比，0.0；95%置信区间，0.0 - 0.7）。相比之下，病例组和对照组乘客在自我评估的手部卫生方面似乎同样合规。
使用口罩并结合手部卫生可能会将航空旅客通过飞沫传播病毒的几率降至最低。因此，卫生措施有必要成为商业航空旅行标准程序的一个组成部分。
