Swisher Samantha, Pourakis George, Gertz Alida M, Ahmed Faruque, Pringle Kristen, Bagley Karla, Shearer Emma, Nguyen Taylor H, Willis-Downing Nyjah, Mathis Adria D, Rubin Lily, Brown Clive, Mase Sundari, Gearhart Shannon
Division of Global Migration Health, National Center for Emerging and Infectious Zoonotic Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA.
J Travel Med. 2025 Aug 30. doi: 10.1093/jtm/taaf090.
Measles transmission on aircraft has been well-documented, and many countries perform contact investigations after exposure events during air travel. This review summarized and updated available evidence for measles transmission risk during commercial air travel to inform best practices for public health response after such exposures.
We searched eight databases for articles and pre-prints about measles and air travel published during 2004-2023. Reviewers screened for articles that contained primary data about measles exposure events on commercial flights. Two reviewers used a piloted data extraction template to collect information from each article, including flight characteristics, approach to contact investigation, and outcomes. Risk of bias was assessed using the Mixed Methods Appraisal Tool.
The initial literature search identified 196 articles, of which 19 met the inclusion criteria. These articles described contact investigations performed for ≥182 flights, which identified 70 secondary cases associated with 144 index cases. In articles where the contact investigation did not include the whole plane, many secondary cases were seated outside the contact zone, as defined by the investigation. Among secondary cases where vaccination status was known, 73% (40/55) were unvaccinated, and vaccination rates among cases <18 years of age were especially low (3/18, 17%). Uptake of post-exposure prophylaxis was low in the few articles that reported this information.
Measles transmission on aircraft is an established risk, especially for persons that are unvaccinated, and can affect passengers seated outside of the rows immediately around the index case. The available information suggests many barriers to provision of post exposure prophylaxis, and routine vaccination likely remains the best protection against measles outbreaks associated with air travel. However, most studies were designed and reported in a way that did not support robust analysis of the best approaches to contact investigation or the most effective way to prevent secondary cases.
飞机上的麻疹传播已有充分记录，许多国家在航空旅行期间发生暴露事件后会进行接触者调查。本综述总结并更新了商业航空旅行期间麻疹传播风险的现有证据，以为此类暴露后公共卫生应对的最佳实践提供参考。
我们在八个数据库中搜索了2004年至2023年期间发表的关于麻疹与航空旅行的文章和预印本。评审人员筛选包含商业航班上麻疹暴露事件原始数据的文章。两名评审人员使用预先测试的数据提取模板从每篇文章中收集信息，包括航班特征、接触者调查方法和结果。使用混合方法评估工具评估偏倚风险。
初步文献检索确定了196篇文章，其中19篇符合纳入标准。这些文章描述了对≥182个航班进行的接触者调查，共识别出与144例索引病例相关的70例二代病例。在接触者调查未涵盖整架飞机的文章中，许多二代病例坐在调查所定义的接触区域之外。在已知疫苗接种状况的二代病例中，73%（40/55）未接种疫苗，18岁以下病例的疫苗接种率尤其低（3/18，17%）。在少数报告了此信息的文章中，暴露后预防措施的采用率较低。
飞机上的麻疹传播是一种既定风险，尤其是对于未接种疫苗的人，并且可能影响坐在索引病例周围紧邻排之外的乘客。现有信息表明提供暴露后预防措施存在许多障碍，常规疫苗接种可能仍然是预防与航空旅行相关的麻疹爆发的最佳保护措施。然而，大多数研究的设计和报告方式不支持对接触者调查的最佳方法或预防二代病例的最有效方法进行有力分析。
