Heinrich Joachim, Zhao Tianyu, Quartucci Caroline, Herbig Britta, Nowak Dennis
Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin Universitätsklinikum, LMU, Universitätsklinikum, LMU, München, Deutschland.
Helmholtz Zentrum Munchen Deutsches Forschungszentrum fur Gesundheit und Umwelt, Institut für Epidemiologie, Neuherberg, Deutschland.
Gesundheitswesen. 2021 Sep;83(8-09):581-592. doi: 10.1055/a-1531-5264. Epub 2021 Sep 8.
The aim of this review is to identify epidemiological studies on the risk of infection with SARS-CoV-2 during travel by train and bus and to critically evaluate them also with regard to extrapolating the findings to the German situation.
Systematic review based on searching two electronic databases (PubMed, Web of Science) according to the principle of Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) for epidemiological studies on SARS-CoV-2 or COVID-19 and travel by train or bus.
Searches of the two electronic databases yielded 746 publications. Of these, 55 met the selection criteria and were included in the full-text search. Finally, 5 original publications were used to answer the question about SARS-CoV-2 infections related to long-distance travel by train and 4 related to bus travel. The studies were very heterogeneous and referred almost exclusively to long-distance travel in China. They consistently showed a risk of infection when infected persons travelled in the same train, car or bus without mouth-to-nose (MNB) coverage. The risk was not limited to those sitting in close proximity to an infected fellow traveler. Despite all the differences between travel by train and bus in China and Germany, there is no fundamental doubt that the reported results from China can also be extrapolated to Germany in qualitative terms. However, it must be taken into account that the results of the three key publications predominantly included the period before the lockdown in China without the strict use of MNB. Thus, the question remains whether the results would be similar under current conditions with MNB and more virulent viral mutations. No single study was found related to infection when using public transportation.
There are several lines of evidence that travel by train is associated with a significantly lower risk of infection compared with the risk of infection in the home environment. Due to a lack of observational data, one will need to model the risk of infection for long-distance travel by bus and use of local public transport based on air exchange in the passenger compartment, travel duration, distance from other passengers, and ultimately passenger density.
本综述旨在识别关于乘坐火车和公交车旅行期间感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）风险的流行病学研究，并就将研究结果外推至德国情况进行批判性评估。
根据系统评价与荟萃分析优先报告项目（PRISMA）原则，对两个电子数据库（PubMed、Web of Science）进行检索，以获取关于SARS-CoV-2或2019冠状病毒病（COVID-19）以及乘坐火车或公交车旅行的流行病学研究，从而进行系统评价。
对两个电子数据库的检索产生了746篇出版物。其中，55篇符合入选标准并纳入全文检索。最终，5篇原始出版物用于回答与乘坐火车长途旅行相关的SARS-CoV-2感染问题，4篇用于回答与乘坐公交车旅行相关的问题。这些研究差异很大，几乎都只涉及中国的长途旅行。它们一致表明，当感染者在同一列火车、汽车或公交车上旅行且未佩戴口鼻覆盖物时存在感染风险。该风险不限于与感染同行者近距离就坐的人。尽管中国和德国在火车和公交车旅行方面存在所有差异，但毫无疑问，中国报告的结果在定性方面也可外推至德国。然而，必须考虑到，三篇关键出版物的结果主要涵盖中国封锁前的时期，当时未严格使用口鼻覆盖物。因此，问题仍然是在当前使用口鼻覆盖物和病毒更具毒性变异的情况下结果是否会相似。未发现与使用公共交通工具时感染相关的单一研究。
有几条证据表明，与家庭环境中的感染风险相比，乘坐火车旅行的感染风险显著更低。由于缺乏观察数据，需要根据车厢内的空气交换、旅行持续时间、与其他乘客的距离以及最终的乘客密度，对乘坐公交车长途旅行和使用当地公共交通工具的感染风险进行建模。
