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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2010. Research on the Transmission of Disease in Airports and on Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/22941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2010. Research on the Transmission of Disease in Airports and on Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/22941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2010. Research on the Transmission of Disease in Airports and on Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/22941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2010. Research on the Transmission of Disease in Airports and on Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/22941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2010. Research on the Transmission of Disease in Airports and on Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/22941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2010. Research on the Transmission of Disease in Airports and on Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/22941.
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C o n f e r e n C e P r o C e e d i n g s 4 7 Research on the Transmission of Disease in Airports and on Aircraft Summary of a Symposium CHRISTINE L. GERENCHER, Transportation Research Board Rapporteur September 17–18, 2009 The Keck Center of the National Academies Washington, D.C. Sponsored by Airport Cooperative Research Program Transportation Research Board Washington, D.C. 2010 www.TRB.org

Transportation Research Board Conference Proceedings 47 ISSN 1073- 1652 ISBN 978-0-309-14295-3 Subscriber Category V aviation Transportation Research Board (TRB) publications are available by ordering individual publications directly from the TRB Business Office, through the Internet at www.TRB.org or national-academies.org/trb, or by annual subscription through organizational or indi- vidual affiliation with TRB. Affiliates and library subscribers are eligible for substantial discounts. For further information, contact the TRB Business Office, 500 Fifth Street, NW, Washington, DC 20001 (telephone 202-334-3213; fax 202-334-2519; or e-mail TRBsales@ nas.edu). Printed in the United States of America. NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the project were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to the procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This project was sponsored by the Airport Cooperative Research Program and the Transportation Research Board. Committee on Research on the Transmission of Disease in Airports and on Aircraft: A Symposium Katherine Andrus, Air Transport Association, Chair Alan Black, Dallas–Ft. Worth International Airport Anthony D. B. Evans, International Civil Aviation Organization Mark Gendreau, Lahey Clinic Medical Center and Tufts University School of Medicine Marc Lipsitch, Harvard School of Public Health, Department of Epidemiology John C. Neatherlin, Centers for Disease Control and Prevention Chris Seher, Department of Homeland Security John “Jack” Spengler, Harvard School of Public Health Jennifer Topmiller, National Institute for Occupational Safety and Health Jeanne C. Yu, Boeing Commercial Airplanes Symposium Planning Committee Liaison Jean Watson, Federal Aviation Administration TRB Staff Mark Norman, Director, Technical Activities Christine Gerencher, Senior Program Officer for Aviation and Environment Freda Morgan, Senior Program Associate TRB Publications Office Cay Butler, Editor Javy Awan, Production Editor Jennifer J. Weeks, Manuscript Preparation Juanita Green, Production Manager Cover design by Beth Schlenoff, Beth Schlenoff Design Typesetting by Carol Levie, Grammarians

The National Academy of Sciences is a private, nonprofit, self- perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. On the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also spon- sors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters per- taining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, on its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of further- ing knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both the Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. The Transportation Research Board is one of six major divisions of the National Research Council. The mission of the Transportation Research Board is to provide leadership in transportation inno- vation and progress through research and information exchange, conducted within a setting that is objective, interdisciplinary, and multimodal. The Board’s varied activities annually engage about 7,000 engineers, scientists, and other transportation researchers and practitioners from the public and private sectors and academia, all of whom contribute their expertise in the public interest. The program is supported by state transportation departments, federal agencies including the component administrations of the U.S. Department of Transportation, and other organizations and individuals interested in the development of transportation. www.TRB.org www.national-academies.org

Contents PREFACE ................................................................................................................................................ 1 OVERVIEW ............................................................................................................................................. 3 Christine L. Gerencher Session 1 UNDERSTANDING HOW DISEASE IS TRANSMITTED VIA AIR TRAVEL The Aircraft Cabin Environment .............................................................................................................5 Jeanne Yu (Presenter) Human Movement Patterns and the Spread of Infectious Diseases ...........................................................7 Ben S. Cooper (Presenter) Session 2 PRACTICAL CASE-RESPONSE APPROACHES TO INVESTIGATING THE SPREAD OF DISEASE IN AIRPORTS AND ON AIRCRAFT Norovirus Transmission on Aircraft .......................................................................................................12 Dan Fishbein (Presenter), Hannah L. Kirking, Jennifer Cortes, Sherry Burrer, Aron Hall, Nicole J. Cohen, Harvey Lipman, Curi Kim, and Elizabeth R. Daly Swine Flu A/H1N1 Transmission via the Aviation Sector ......................................................................12 Itamar Grotto (Presenter), Shepherd Roee Singer, and Emilia Anis Session 3 THEORETICAL MODELING APPROACHES TO INVESTIGATING THE SPREAD OF DISEASE IN AIRPORTS AND ON AIRCRAFT Summarizing Exposure Patterns on Commercial Aircraft .......................................................................15 James S. Bennett (Presenter), Jennifer L. Topmiller, Yuanhui Zhang, and Watts L. Dietrich

Advance Models for Predicting Contaminants and Infectious Disease Virus Transport in the Airliner Cabin Environment (Part 1) .................................................................................................21 Qingyan (Yan) Chen (Presenter), Sagnik Mazumdar, Michael W. Plesniak, Stephane Poussou, Paul E. Sojka, Tengfei Zhang, and Zhao Zhang Advance Models for Predicting Contaminants and Infectious Disease Virus Transport in the Airliner Cabin Environment (Part 2) .................................................................................................28 Byron Jones (Presenter) Characterizing the Risk of Tuberculosis Infection in Commercial Aircraft by Using Quantitative Microbial Risk Assessment .................................................................................................35 Joan B. Rose (Presenter) and Mark H. Weir Session 4 EXPERIMENTAL “BENCH SCIENCE” APPROACHES TO INVESTIGATING THE SPREAD OF DISEASE IN AIRPORTS AND ON AIRCRAFT Interventions for Preventing the Transmission of Influenza Virus ...........................................................39 James J. McDevitt and Donald K. Milton The Role of Fomites in the Transmission of Pathogens in Airports and on Aircraft ...............................41 Charles P. Gerba Session 5 POLICIES AND PLANNING TO MINIMIZE THE SPREAD OF DISEASE Transmission Patterns of Mosquito-Borne Infectious Diseases During Air Travel: Passengers, Pathogens, and Public Health Implications ...........................................................................43 James H. Diaz (Presenter) Airline Policies and Procedures to Minimize the Spread of Diseases .......................................................48 Rose M. Ong (Presenter) The Practical Application of World Health Organization Travel Recommendations: Some Observations .................................................................................................................................49 Anthony D. B. Evans (Presenter) Session 6 DISCUSSION OF TOPICS FOR FUTURE RESEARCH ....................................................................... 51 Appendix A SYMPOSIUM AGENDA ........................................................................................................................54 Appendix B REFERENCE MATERIALS .................................................................................................................. 56

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TRB Conference Proceedings 47: Research on the Transmission of Disease in Airports and on Aircraft is the summary of a September 2009 symposium. The symposium examined the status of research on or related to the transmission of disease on aircraft and in airports, and the potential application of research results to the development of protocols and standards for managing communicable disease incidents in an aviation setting. The symposium also explored areas where additional research may be needed.

An article on this report was included in the January-February issue of the TR News.

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