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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Predicting the potential for within-flight transmission and global dissemination of MERS</title><author><name sortKey="Coburn, Brian J" sort="Coburn, Brian J" uniqKey="Coburn B" first="Brian J" last="Coburn">Brian J. Coburn</name><affiliation><nlm:aff id="aff1">Center for Biomedical Modeling, Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA</nlm:aff></affiliation></author><author><name sortKey="Blower, Sally" sort="Blower, Sally" uniqKey="Blower S" first="Sally" last="Blower">Sally Blower</name><affiliation><nlm:aff id="aff1">Center for Biomedical Modeling, Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24457166</idno><idno type="pmc">7129393</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7129393</idno><idno type="RBID">PMC:7129393</idno><idno type="doi">10.1016/S1473-3099(13)70358-X</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000880</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000880</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Predicting the potential for within-flight transmission and global dissemination of MERS</title><author><name sortKey="Coburn, Brian J" sort="Coburn, Brian J" uniqKey="Coburn B" first="Brian J" last="Coburn">Brian J. Coburn</name><affiliation><nlm:aff id="aff1">Center for Biomedical Modeling, Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA</nlm:aff></affiliation></author><author><name sortKey="Blower, Sally" sort="Blower, Sally" uniqKey="Blower S" first="Sally" last="Blower">Sally Blower</name><affiliation><nlm:aff id="aff1">Center for Biomedical Modeling, Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA</nlm:aff></affiliation></author></analytic><series><title level="j">The Lancet. Infectious Diseases</title><idno type="ISSN">1473-3099</idno><idno type="eISSN">1474-4457</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Assiri, A" uniqKey="Assiri A">A Assiri</name></author><author><name sortKey="Al Tawfiq, Ja" uniqKey="Al Tawfiq J">JA Al-Tawfiq</name></author><author><name sortKey="Al Rabeeah, Aa" uniqKey="Al Rabeeah A">AA Al-Rabeeah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Breban, R" uniqKey="Breban R">R Breban</name></author><author><name sortKey="Riou, J" uniqKey="Riou J">J Riou</name></author><author><name sortKey="Fontanet, A" uniqKey="Fontanet A">A Fontanet</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cauchemez, S" uniqKey="Cauchemez S">S Cauchemez</name></author><author><name sortKey="Fraser, C" uniqKey="Fraser C">C Fraser</name></author><author><name sortKey="Van Kerkhove, Md" uniqKey="Van Kerkhove M">MD Van Kerkhove</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mangili, A" uniqKey="Mangili A">A Mangili</name></author><author><name sortKey="Gendreau, Ma" uniqKey="Gendreau M">MA Gendreau</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wagner, Bg" uniqKey="Wagner B">BG Wagner</name></author><author><name sortKey="Coburn, Bj" uniqKey="Coburn B">BJ Coburn</name></author><author><name sortKey="Blower, S" uniqKey="Blower S">S Blower</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wells, Wf" uniqKey="Wells W">WF Wells</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Lancet Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">Lancet Infect Dis</journal-id><journal-title-group><journal-title>The Lancet. Infectious Diseases</journal-title></journal-title-group><issn pub-type="ppub">1473-3099</issn><issn pub-type="epub">1474-4457</issn><publisher><publisher-name>Elsevier Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24457166</article-id><article-id pub-id-type="pmc">7129393</article-id><article-id pub-id-type="publisher-id">S1473-3099(13)70358-X</article-id><article-id pub-id-type="doi">10.1016/S1473-3099(13)70358-X</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Predicting the potential for within-flight transmission and global dissemination of MERS</article-title></title-group><contrib-group><contrib contrib-type="author" id="au10"><name><surname>Coburn</surname><given-names>Brian J</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au20"><name><surname>Blower</surname><given-names>Sally</given-names></name><email>sblower@mednet.ucla.edu</email><xref rid="aff1" ref-type="aff">a</xref></contrib></contrib-group><aff id="aff1"><label>a</label>Center for Biomedical Modeling, Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA</aff><pub-date pub-type="pmc-release"><day>20</day><month>1</month><year>2014</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><month>2</month><year>2014</year></pub-date><pub-date pub-type="epub"><day>20</day><month>1</month><year>2014</year></pub-date><volume>14</volume><issue>2</issue><fpage>99</fpage><lpage>99</lpage><permissions><copyright-statement>Copyright © 2014 Elsevier Ltd. All rights reserved.</copyright-statement><copyright-year>2014</copyright-year><copyright-holder>Elsevier Ltd</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><related-article related-article-type="article-reference" id="d32e242" ext-link-type="doi" xlink:href="10.1016/S1473-3099(13)70204-4"></related-article></article-meta></front><body><p id="para10">We read with interest Abdullah Assiri and colleagues'<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref> report about the recent emergence of a new pathogen, Middle East respiratory syndrome coronavirus (MERS-CoV). MERS-CoV has an epicentre in Saudi Arabia, but cases have been reported from Italy, France, Germany, Tunisia, and the UK.<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref> The basic reproduction number (R<sub>0</sub>) of MERS-CoV has been estimated to be less than one, indicating that the virus is unlikely to cause an epidemic.<xref rid="bib2" ref-type="bibr">2</xref>, <xref rid="bib3" ref-type="bibr">3</xref> However, we note that even when the R<sub>0</sub> of a pathogen is below one it can be transmitted during long-distance flights.<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref> Within-flight transmission has been documented for influenza, measles, smallpox, tuberculosis, and severe acute respiratory syndrome.<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref> We used a mathematical model to predict the potential for within-flight transmission of MERS-CoV.<xref rid="bib5" ref-type="bibr"><sup>5</sup></xref> Specifically, we predicted the number of new infections that could be caused by one person with MERS-CoV taking a long-distance flight. The model was parameterised to reflect conditions in a Boeing 747, and MERS-CoV infectivity was defined in terms of infectious quanta per hour.<xref rid="bib6" ref-type="bibr"><sup>6</sup></xref> We assumed, on the basis of existing data, that MERS is less infectious than influenza, which has an infectivity of about 100 quanta per hour (range 79–128).<xref rid="bib2" ref-type="bibr">2</xref>, <xref rid="bib5" ref-type="bibr">5</xref> We set the infectivity of MERS-CoV at about 50 quanta per hour (range 6–140).</p><p id="para20">Our modelling shows transmission will be confined to the cabin where the index case is located. The figure shows the outcome of 10 000 scenarios, with a different value for the infectivity of MERS-CoV used in each. On a 5 h flight (eg, from Saudi Arabia to Pakistan), roughly one infection could occur if the index case travels by first class, and roughly three infections could occur if he or she travels in economy. On a 13 h flight (eg, from Saudi Arabia to New York), the number of infections would double. Notably, a superspreader on a 13 h flight, releasing about 140 quanta per hour, could cause roughly four infections in first class or 15 infections in economy.</p><p id="para30">Although the risk to public health (ie, the number of infections) are greatest if the index case travels by economy rather than by first class, the per-passenger risk of becoming infected with MERS-CoV is greatest if the index case travels by first class rather than by economy (<xref rid="fig1" ref-type="fig">figure</xref>). Over 5 h, the risk would be about 3% in first class versus about 1% in economy for a fully occupied flight; correspondingly, the risk would be about 8% versus 2% on a 13 h flight. The risk is substantially greater if the index case is a superspreader; for example, if the index case releases 140 quanta per hour and takes a 13 h flight, the per-passenger risk would be about 16% for first-class travel and 5% for economy travel.<fig id="fig1"><label>Figure 1</label><caption><p>Within-flight transmission of MERS-CoV</p><p>Each probablity distribution is based on 10 000 scenarios with different levels of index-case infectivity. Red lines represent predictions for which the index case travels by economy, and blue lines represent travel by first class. Solid lines represent predictions for a 5 h flight and dotted lines show predictions for a 13 h flight. (A) The predicted number of infections caused by one infectious case of MERS during a long-distance flight. (B) The predicted per-passenger risk of infection due to one infectious case of MERS during a long-distance flight.</p></caption><graphic xlink:href="gr1_lrg"></graphic></fig></p><p id="para40">Our modelling suggests that, if within-flight transmission of MERS-CoV occurs, one infectious individual could cause multiple simultaneous outbreaks in several different countries. Therefore, even if MERS-CoV does not have the potential to cause an epidemic,<xref rid="bib2" ref-type="bibr">2</xref>, <xref rid="bib3" ref-type="bibr">3</xref> the probability of global dissemination of this new pathogen could be high.</p><p id="para320a"><boxed-text id="cetextbox10"><p id="para330b"><bold>This online publication has been corrected. The corrected version first appeared at thelancet.com/specialty on July 20, 2015</bold></p></boxed-text></p></body><back><ref-list id="bibl10"><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="journal" id="sbref10"><person-group person-group-type="author"><name><surname>Assiri</surname><given-names>A</given-names></name><name><surname>Al-Tawfiq</surname><given-names>JA</given-names></name><name><surname>Al-Rabeeah</surname><given-names>AA</given-names></name></person-group><article-title>Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study</article-title><source>Lancet Infect Dis</source><volume>13</volume><year>2013</year><fpage>752</fpage><lpage>761</lpage><pub-id pub-id-type="pmid">23891402</pub-id></element-citation></ref><ref id="bib2"><label>2</label><element-citation publication-type="journal" id="sbref20"><person-group person-group-type="author"><name><surname>Breban</surname><given-names>R</given-names></name><name><surname>Riou</surname><given-names>J</given-names></name><name><surname>Fontanet</surname><given-names>A</given-names></name></person-group><article-title>Interhuman transmissibility of Middle East respiratory syndrome coronavirus: estimation of pandemic risk</article-title><source>Lancet</source><volume>382</volume><year>2013</year><fpage>694</fpage><lpage>699</lpage><pub-id pub-id-type="pmid">23831141</pub-id></element-citation></ref><ref id="bib3"><label>3</label><element-citation publication-type="journal" id="sbref30"><person-group person-group-type="author"><name><surname>Cauchemez</surname><given-names>S</given-names></name><name><surname>Fraser</surname><given-names>C</given-names></name><name><surname>Van Kerkhove</surname><given-names>MD</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility</article-title><source>Lancet Infect Dis</source><volume>14</volume><year>2014</year><fpage>50</fpage><lpage>56</lpage><pub-id pub-id-type="pmid">24239323</pub-id></element-citation></ref><ref id="bib4"><label>4</label><element-citation publication-type="journal" id="sbref40"><person-group person-group-type="author"><name><surname>Mangili</surname><given-names>A</given-names></name><name><surname>Gendreau</surname><given-names>MA</given-names></name></person-group><article-title>Transmission of infectious diseases during commercial air travel</article-title><source>Lancet</source><volume>365</volume><year>2005</year><fpage>989</fpage><lpage>996</lpage><pub-id pub-id-type="pmid">15767002</pub-id></element-citation></ref><ref id="bib5"><label>5</label><element-citation publication-type="journal" id="sbref50"><person-group person-group-type="author"><name><surname>Wagner</surname><given-names>BG</given-names></name><name><surname>Coburn</surname><given-names>BJ</given-names></name><name><surname>Blower</surname><given-names>S</given-names></name></person-group><article-title>Calculating the potential for within-flight transmission of influenza A (H1N1)</article-title><source>BMC Med</source><volume>7</volume><year>2009</year><fpage>81</fpage><pub-id pub-id-type="pmid">20034378</pub-id></element-citation></ref><ref id="bib6"><label>6</label><element-citation publication-type="journal" id="sbref60"><person-group person-group-type="author"><name><surname>Wells</surname><given-names>WF</given-names></name></person-group><article-title>On air-borne infection: study II—droplets and droplet nuclei</article-title><source>Am J Hyg</source><volume>20</volume><year>1934</year><fpage>611</fpage><lpage>618</lpage></element-citation></ref></ref-list><ack><p>We declare that we have no conflicts of interest. This work was supported by National Institute of Health Award R01 AI041935.</p></ack></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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