title: Recurring norovirus transmission on an airplane.
abstract: BACKGROUND
  Previously reported outbreaks of norovirus gastroenteritis associated with aircraft have been limited to transmission during a single flight sector. During October 2009, an outbreak of diarrhea and vomiting occurred among different groups of flight attendants who had worked on separate flight sectors on the same airplane. We investigated the cause of the outbreak and whether the illnesses were attributable to work on the airplane.
  
  
  METHODS
  Information was obtained from flight attendants on demographic characteristics, symptoms, and possible transmission risk factors. Case patients were defined as flight attendants with diarrhea or vomiting <51 hours after the end of their first flight sector on the airplane during 13-18 October 2009. Stool samples were tested for norovirus RNA.
  
  
  RESULTS
  A passenger had vomited on the Boeing 777-200 airplane on the 13 October flight sector. Sixty-three (82%) of 77 flight attendants who worked on the airplane during 13-18 October provided information, and 27 (43%) met the case definition. The attack rate among flight attendants decreased significantly over successive flight sectors from 13 October onward (P < .001). Working as a supervisor was independently associated with development of illness (adjusted odds ratio, 5.8; 95% confidence interval, 1.3-25.6). Norovirus genotype GI.6 was detected in stool samples from 2 case patients who worked on different flight sectors.
  
  
  CONCLUSIONS
  Sustained transmission of norovirus is likely to have occurred because of exposures on this airplane during successive flight sectors. Airlines should make provision for adequate disinfection of airplanes with use of products effective against norovirus and other common infectious agents after vomiting has occurred.
authors.affiliation: Auckland Regional Public Health Service, Auckland District Health Board, Auckland, New Zealand. craigt@adhb.govt.nz
authors.forename: Craig N
authors.initials: CN
authors.lastname: Thornley
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Emslie
authors.forename: Tim W
authors.initials: TW
authors.lastname: Sprott
authors.forename: Gail E
authors.initials: GE
authors.lastname: Greening
authors.forename: Jackie P
authors.initials: JP
authors.lastname: Rapana
mesh_terms: D000328:Adult; D000401:Aircraft; D000704:Analysis of Variance; D017250:Caliciviridae Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission* / Q000821:virology; D016009:Chi-Square Distribution; D004196:Disease Outbreaks; D004203:Disinfection; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D029322:Norovirus / Q000302:isolation & purification*; D012307:Risk Factors; D014195:Travel