title: Likely transmission of norovirus on an airplane, October 2008.
abstract: BACKGROUND
  On 8 October 2008, members of a tour group experienced diarrhea and vomiting throughout an airplane flight from Boston, Massachusetts, to Los Angeles, California, resulting in an emergency diversion 3 h after takeoff. An investigation was conducted to determine the cause of the outbreak, assess whether transmission occurred on the airplane, and describe risk factors for transmission.
  
  
  METHODS
  Passengers and crew were contacted to obtain information about demographics, symptoms, locations on the airplane, and possible risk factors for transmission. Case patients were defined as passengers with vomiting or diarrhea (> or =3 loose stools in 24 h) and were asked to submit stool samples for norovirus testing by real-time reverse-transcription polymerase chain reaction.
  
  
  RESULTS
  Thirty-six (88%) of 41 tour group members were interviewed, and 15 (41%) met the case definition (peak date of illness onset, 8 October 2008). Of 106 passengers who were not tour group members, 85 (80%) were interviewed, and 7 (8%) met the case definition after the flight (peak date of illness onset, 10 October 2008). Multivariate logistic regression analysis showed that sitting in an aisle seat (adjusted relative risk, 11.0; 95% confidence interval, 1.4-84.9) and sitting near any tour group member (adjusted relative risk, 7.5; 95% confidence interval, 1.7-33.6) were associated with the development of illness. Norovirus genotype II was detected by reverse-transcription polymerase chain reaction in stool samples from case patients in both groups.
  
  
  CONCLUSIONS
  Despite the short duration, transmission of norovirus likely occurred during the flight.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Kirking
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cortes
authors.forename: Sherry
authors.initials: S
authors.lastname: Burrer
authors.forename: Aron J
authors.initials: AJ
authors.lastname: Hall
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Cohen
authors.forename: Harvey
authors.initials: H
authors.lastname: Lipman
authors.forename: Curi
authors.initials: C
authors.lastname: Kim
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Daly
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Fishbein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000401:Aircraft; D001900:Boston; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000635:transmission*; D003967:Diarrhea / Q000453:epidemiology; D004196:Disease Outbreaks; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D015141:Los Angeles; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D029322:Norovirus / Q000302:isolation & purification*; D014839:Vomiting / Q000453:epidemiology; D055815:Young Adult