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Open Access Highly Accessed Research article

Timeliness of contact tracing among flight passengers for influenza A/H1N1 2009

Corien M Swaan1*, Rolf Appels2, Mirjam EE Kretzschmar34 and Jim E van Steenbergen1

Author Affiliations

1 Preparedness and Response Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, the Netherlands

2 Municipal Health Service, GGD Kennemerland, Spaarnepoort 5, 2134 TM Hoofddorp, the Netherlands

3 Julius Centre for Health Sciences & Primary Care, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands

4 Epidemiology and Surveillance Unit; Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, the Netherlands

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BMC Infectious Diseases 2011, 11:355  doi:10.1186/1471-2334-11-355

Published: 28 December 2011

Abstract

Background

During the initial containment phase of influenza A/H1N1 2009, close contacts of cases were traced to provide antiviral prophylaxis within 48 h after exposure and to alert them on signs of disease for early diagnosis and treatment. Passengers seated on the same row, two rows in front or behind a patient infectious for influenza, during a flight of ≥ 4 h were considered close contacts. This study evaluates the timeliness of flight-contact tracing (CT) as performed following national and international CT requests addressed to the Center of Infectious Disease Control (CIb/RIVM), and implemented by the Municipal Health Services of Schiphol Airport.

Methods

Elapsed days between date of flight arrival and the date passenger lists became available (contact details identified - CI) was used as proxy for timeliness of CT. In a retrospective study, dates of flight arrival, onset of illness, laboratory diagnosis, CT request and identification of contacts details through passenger lists, following CT requests to the RIVM for flights landed at Schiphol Airport were collected and analyzed.

Results

24 requests for CT were identified. Three of these were declined as over 4 days had elapsed since flight arrival. In 17 out of 21 requests, contact details were obtained within 7 days after arrival (81%). The average delay between arrival and CI was 3,9 days (range 2-7), mainly caused by delay in diagnosis of the index patient after arrival (2,6 days). In four flights (19%), contacts were not identified or only after > 7 days. CI involving Dutch airlines was faster than non-Dutch airlines (P < 0,05). Passenger locator cards did not improve timeliness of CI. In only three flights contact details were identified within 2 days after arrival.

Conclusion

CT for influenza A/H1N1 2009 among flight passengers was not successful for timely provision of prophylaxis. CT had little additional value for alerting passengers for disease symptoms, as this information already was provided during and after the flight. Public health authorities should take into account patient delays in seeking medical advise and laboratory confirmation in relation to maximum time to provide postexposure prophylaxis when deciding to install contact tracing measures. International standardization of CT guidelines is recommended.