Empirical Evidence for the Effect of Airline Travel on Inter-Regional Influenza Spread in the United States
Identifieur interne : 000C23 ( Pmc/Curation ); précédent : 000C22; suivant : 000C24Empirical Evidence for the Effect of Airline Travel on Inter-Regional Influenza Spread in the United States
Auteurs : John S. Brownstein [États-Unis] ; Cecily J. Wolfe [États-Unis] ; Kenneth D. Mandl [États-Unis]Source :
- PLoS Medicine [ 1549-1277 ] ; 2006.
Abstract
The influence of air travel on influenza spread has been the subject of numerous investigations using simulation, but very little empirical evidence has been provided. Understanding the role of airline travel in large-scale influenza spread is especially important given the mounting threat of an influenza pandemic. Several recent simulation studies have concluded that air travel restrictions may not have a significant impact on the course of a pandemic. Here, we assess, with empirical data, the role of airline volume on the yearly inter-regional spread of influenza in the United States.
We measured rate of inter-regional spread and timing of influenza in the United States for nine seasons, from 1996 to 2005 using weekly influenza and pneumonia mortality from the Centers for Disease Control and Prevention. Seasonality was characterized by band-pass filtering. We found that domestic airline travel volume in November (mostly surrounding the Thanksgiving holiday) predicts the rate of influenza spread (
We provide the first empirical evidence for the role of airline travel in long-range dissemination of influenza. Our results suggest an important influence of international air travel on the timing of influenza introduction, as well as an influence of domestic air travel on the rate of inter-regional influenza spread in the US. Pandemic preparedness strategies should account for a possible benefit of airline travel restrictions on influenza spread.
Url:
DOI: 10.1371/journal.pmed.0030401
PubMed: 16968115
PubMed Central: 1564183
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Brownstein</name><affiliation wicri:level="1"><nlm:aff id="aff1">Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3">Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pediatrics, Harvard Medical School, Boston, Massachusetts</wicri:regionArea></affiliation></author><author><name sortKey="Wolfe, Cecily J" sort="Wolfe, Cecily J" uniqKey="Wolfe C" first="Cecily J" last="Wolfe">Cecily J. Wolfe</name><affiliation wicri:level="1"><nlm:aff id="aff1">Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4">Hawaii Institute of Geophysics and Planetology, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Hawaii Institute of Geophysics and Planetology, University of Hawaii at Manoa, Honolulu, Hawaii</wicri:regionArea></affiliation></author><author><name sortKey="Mandl, Kenneth D" sort="Mandl, Kenneth D" uniqKey="Mandl K" first="Kenneth D" last="Mandl">Kenneth D. Mandl</name><affiliation wicri:level="1"><nlm:aff id="aff1">Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3">Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pediatrics, Harvard Medical School, Boston, Massachusetts</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">16968115</idno><idno type="pmc">1564183</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564183</idno><idno type="RBID">PMC:1564183</idno><idno type="doi">10.1371/journal.pmed.0030401</idno><date when="2006">2006</date><idno type="wicri:Area/Pmc/Corpus">000C23</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000C23</idno><idno type="wicri:Area/Pmc/Curation">000C23</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000C23</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Empirical Evidence for the Effect of Airline Travel on Inter-Regional Influenza Spread in the United States</title><author><name sortKey="Brownstein, John S" sort="Brownstein, John S" uniqKey="Brownstein J" first="John S" last="Brownstein">John S. Brownstein</name><affiliation wicri:level="1"><nlm:aff id="aff1">Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3">Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pediatrics, Harvard Medical School, Boston, Massachusetts</wicri:regionArea></affiliation></author><author><name sortKey="Wolfe, Cecily J" sort="Wolfe, Cecily J" uniqKey="Wolfe C" first="Cecily J" last="Wolfe">Cecily J. Wolfe</name><affiliation wicri:level="1"><nlm:aff id="aff1">Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4">Hawaii Institute of Geophysics and Planetology, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Hawaii Institute of Geophysics and Planetology, University of Hawaii at Manoa, Honolulu, Hawaii</wicri:regionArea></affiliation></author><author><name sortKey="Mandl, Kenneth D" sort="Mandl, Kenneth D" uniqKey="Mandl K" first="Kenneth D" last="Mandl">Kenneth D. Mandl</name><affiliation wicri:level="1"><nlm:aff id="aff1">Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3">Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pediatrics, Harvard Medical School, Boston, Massachusetts</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS Medicine</title><idno type="ISSN">1549-1277</idno><idno type="eISSN">1549-1676</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background</title><p>The influence of air travel on influenza spread has been the subject of numerous investigations using simulation, but very little empirical evidence has been provided. Understanding the role of airline travel in large-scale influenza spread is especially important given the mounting threat of an influenza pandemic. Several recent simulation studies have concluded that air travel restrictions may not have a significant impact on the course of a pandemic. Here, we assess, with empirical data, the role of airline volume on the yearly inter-regional spread of influenza in the United States.</p></sec><sec id="st2"><title>Methods and Findings</title><p>We measured rate of inter-regional spread and timing of influenza in the United States for nine seasons, from 1996 to 2005 using weekly influenza and pneumonia mortality from the Centers for Disease Control and Prevention. Seasonality was characterized by band-pass filtering. We found that domestic airline travel volume in November (mostly surrounding the Thanksgiving holiday) predicts the rate of influenza spread (<italic>r</italic><sup>2</sup> = 0.60; <italic>p =</italic> 0.014). We also found that international airline travel influences the timing of influenza mortality (<italic>r</italic><sup>2</sup> = 0.59; <italic>p =</italic> 0.016). The flight ban in the US after the terrorist attack on September 11, 2001, and the subsequent depression of the air travel market, provided a natural experiment for the evaluation of flight restrictions; the decrease in air travel was associated with a delayed and prolonged influenza season.</p></sec><sec id="st3"><title>Conclusions</title><p>We provide the first empirical evidence for the role of airline travel in long-range dissemination of influenza. Our results suggest an important influence of international air travel on the timing of influenza introduction, as well as an influence of domestic air travel on the rate of inter-regional influenza spread in the US. Pandemic preparedness strategies should account for a possible benefit of airline travel restrictions on influenza spread.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Grais, Rf" uniqKey="Grais R">RF Grais</name></author><author><name sortKey="Ellis, Jh" uniqKey="Ellis J">JH Ellis</name></author><author><name sortKey="Kress, A" uniqKey="Kress A">A Kress</name></author><author><name sortKey="Glass, Ge" uniqKey="Glass G">GE Glass</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Longini, Im" uniqKey="Longini I">IM Longini</name></author><author><name sortKey="Fine, Pe" uniqKey="Fine P">PE Fine</name></author><author><name sortKey="Thacker, Sb" uniqKey="Thacker S">SB Thacker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rvachev, L" uniqKey="Rvachev L">L Rvachev</name></author><author><name sortKey="Longini, I" uniqKey="Longini I">I 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Med</journal-id><journal-id journal-id-type="iso-abbrev">PLoS Med</journal-id><journal-id journal-id-type="publisher-id">pmed</journal-id><journal-id journal-id-type="publisher-id">plme</journal-id><journal-id journal-id-type="pmc">plosmed</journal-id><journal-title-group><journal-title>PLoS Medicine</journal-title></journal-title-group><issn pub-type="ppub">1549-1277</issn><issn pub-type="epub">1549-1676</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">16968115</article-id><article-id pub-id-type="pmc">1564183</article-id><article-id pub-id-type="doi">10.1371/journal.pmed.0030401</article-id><article-id pub-id-type="publisher-id">06-PLME-RA-0168R2</article-id><article-id pub-id-type="sici">plme-03-10-03</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline"><subject>Infectious Diseases</subject><subject>Epidemiology/Public Health</subject><subject>Health Policy</subject><subject>Statistics</subject></subj-group><subj-group subj-group-type="System Taxonomy"><subject>Epidemiology</subject><subject>Public Health</subject><subject>Infectious Diseases</subject><subject>Travel Medicine</subject></subj-group></article-categories><title-group><article-title>Empirical Evidence for the Effect of Airline Travel on Inter-Regional Influenza Spread in the United States</article-title><alt-title alt-title-type="running-head">Air Travel and Regional Influenza Spread</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Brownstein</surname><given-names>John S</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff3">3</xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Wolfe</surname><given-names>Cecily J</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Mandl</surname><given-names>Kenneth D</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff3">3</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Children's Hospital Informatics Program at the Harvard–MIT Division of Health Sciences and Technology, Boston, Massachusetts, United States of America</aff><aff id="aff2"><label>2</label>Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, United States of America</aff><aff id="aff3"><label>3</label>Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America</aff><aff id="aff4"><label>4</label>Hawaii Institute of Geophysics and Planetology, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America</aff><contrib-group><contrib contrib-type="editor"><name><surname>Galvani</surname><given-names>Alison</given-names></name><role>Academic Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1">Yale University, United States of America</aff><author-notes><corresp id="cor1">* To whom correspondence should be addressed. E-mail: <email>john_brownstein@harvard.edu</email></corresp></author-notes><pub-date pub-type="ppub"><month>10</month><year>2006</year></pub-date><pub-date pub-type="epub"><day>12</day><month>9</month><year>2006</year></pub-date><volume>3</volume><issue>10</issue><elocation-id>e401</elocation-id><history><date date-type="received"><day>27</day><month>2</month><year>2006</year></date><date date-type="accepted"><day>13</day><month>7</month><year>2006</year></date></history><permissions><copyright-statement> © 2006 Brownstein et al.</copyright-statement><copyright-year>2006</copyright-year><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.</license-p></license></permissions><abstract><sec id="st1"><title>Background</title><p>The influence of air travel on influenza spread has been the subject of numerous investigations using simulation, but very little empirical evidence has been provided. Understanding the role of airline travel in large-scale influenza spread is especially important given the mounting threat of an influenza pandemic. Several recent simulation studies have concluded that air travel restrictions may not have a significant impact on the course of a pandemic. Here, we assess, with empirical data, the role of airline volume on the yearly inter-regional spread of influenza in the United States.</p></sec><sec id="st2"><title>Methods and Findings</title><p>We measured rate of inter-regional spread and timing of influenza in the United States for nine seasons, from 1996 to 2005 using weekly influenza and pneumonia mortality from the Centers for Disease Control and Prevention. Seasonality was characterized by band-pass filtering. We found that domestic airline travel volume in November (mostly surrounding the Thanksgiving holiday) predicts the rate of influenza spread (<italic>r</italic><sup>2</sup> = 0.60; <italic>p =</italic> 0.014). We also found that international airline travel influences the timing of influenza mortality (<italic>r</italic><sup>2</sup> = 0.59; <italic>p =</italic> 0.016). The flight ban in the US after the terrorist attack on September 11, 2001, and the subsequent depression of the air travel market, provided a natural experiment for the evaluation of flight restrictions; the decrease in air travel was associated with a delayed and prolonged influenza season.</p></sec><sec id="st3"><title>Conclusions</title><p>We provide the first empirical evidence for the role of airline travel in long-range dissemination of influenza. Our results suggest an important influence of international air travel on the timing of influenza introduction, as well as an influence of domestic air travel on the rate of inter-regional influenza spread in the US. Pandemic preparedness strategies should account for a possible benefit of airline travel restrictions on influenza spread.</p></sec></abstract><abstract abstract-type="toc"><p>Influenza timing and spread in the US from 1996 to 2005 was influenced by the volume of domestic and international air travel. The flight ban after September 11, 2001, was associated with a delayed and prolonged influenza season.</p></abstract><abstract abstract-type="editor"><title>Editors' Summary</title><sec id="sb1a"><title>Background.</title><p>In both the northern and southern hemispheres, influenza epidemics occur annually during the winter “flu season.” Although the disease maps out a remarkably similar pattern in most years, little is known about the specific mechanisms by which geographic spread occurs. Given the perennial possibility of influenza global epidemics (pandemics) such as occurred in 1918, 1957, and 1969, as well as the more recent, localized outbreaks of avian influenza (“bird flu”) in which a high proportion of affected people have died, we need to understand how influenza spreads in order to limit the destructive impact of future pandemics.</p></sec><sec id="sb1b"><title>Why Was This Study Done?</title><p>In theory, airline travel might be expected to play a role in the spread of influenza across large distances. If so, reducing or restricting air travel might be an appropriate public health intervention in the early stages of an influenza pandemic. This study was performed to identify specific effects of air travel on the annual spread of influenza in the United States.</p></sec><sec id="sb1c"><title>What Did the Researchers Do and Find?</title><p>The researchers analyzed weekly government records on deaths from influenza and pneumonia in cities from nine regions of the US during the nine influenza seasons between 1996 and 2005. For each year, they determined the time it took for the epidemic to spread across the US and the date of the national peak in influenza deaths. They then used government estimates of passenger air travel to explore any connection with the timing of the annual flu epidemics.</p><p>The analysis found that the usual time for an influenza epidemic to reach peak levels across the US was approximately two weeks, and that the national peak date fell within two days of the average date, February 17, in five of the nine seasons. In general, influenza was found to spread more slowly during years when the number of domestic air travelers, particularly during November, was lower. Also, the peak of the influenza season was found to come later during years when the number of international air travelers, particularly in September, was lower. These results, based on reported deaths from pneumonia or influenza, were corroborated using data from an influenza virus surveillance program, and could not be explained by variations in winter temperatures or by different types of influenza virus circulating in different years.</p><p>Of note, the peak date of the US influenza season following September 11, 2001, was delayed by 13 days to March 2, consistent with marked reductions in airline travel following the terrorist attack, and then returned to February 17 over the subsequent two influenza seasons as international airline travel returned to its previous levels. In contrast, the investigators found no delay in the 2001–2002 influenza season in France, where flight restrictions were not imposed.</p></sec><sec id="sb1d"><title>What Do These Findings Mean?</title><p>While this study does not demonstrate that travel restriction would be effective in altering the course of a flu pandemic, it does provides evidence that air travel plays a significant role in the annual spread of influenza in the United States. Although other factors, related or unrelated to the decrease in air travel after September 11, may have affected the course of the 2001–2002 influenza season, the general findings across several years suggest that air travel affects both the peak date and the rate of spread of influenza. These findings merit consideration in the process of preparing for the next influenza pandemic.</p></sec><sec id="sb1e"><title>Additional Information.</title><p>Please access these Web sites via the online version of this summary at <ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1371/journal.pmed.0030401">http://dx.doi.org/10.1371/journal.pmed.0030401</ext-link>.</p><list list-type="bullet"><list-item><p>World Health Organization: <ext-link ext-link-type="uri" xlink:href="http://www.who.int/csr/disease/influenza/pandemic/en/">influenza pandemic preparedness page</ext-link></p></list-item><list-item><p>US Department of Health and Human Services: <ext-link ext-link-type="uri" xlink:href="http://www.pandemicflu.gov">avian and pandemic flu information site</ext-link></p></list-item><list-item><p>Wikipedia page on <ext-link ext-link-type="uri" xlink:href="http://en.wikipedia.org/wiki/Pandemic_influenza">influenza pandemic </ext-link>(note: Wikipedia is a free Internet encyclopedia that anyone can edit)</p></list-item></list></sec></abstract><counts><page-count count="10"></page-count></counts><custom-meta-group><custom-meta><meta-name>citation</meta-name><meta-value>Brownstein JS, Wolfe CJ, Mandl KD (2006) Empirical evidence for the effect of airline travel on inter-regional influenza spread in the United States. PLoS Med 3(10): e401. DOI: <ext-link ext-link-type="doi" xlink:href="10.1371/journal.pmed.0030401">10.1371/journal.pmed.0030401</ext-link></meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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