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An outbreak of 59 cases of coronavirus disease (COVID-19) originated with 13 cases linked by a 7 h, 17% occupancy flight into Ireland, summer 2020. The flight-associated attack rate was 9.8–17.8%. Spread to 46 non-flight cases occurred country-wide. Asymptomatic/pre-symptomatic transmission in-flight from a point source is implicated by 99% homology across the virus genome in five cases travelling from three different continents. Restriction of movement on arrival and robust contact tracing can limit propagation post-flight.


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  1. European Centre for Disease Prevention and Control (ECDC). Contact tracing: public health management of persons, including healthcare workers, having had contact with COVID-19casesin the European Union–second update. Stockholm: ECDC; 8 Apr 2020. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/Contact-tracing-Public-health-management-persons-including-healthcare-workers-having-had-contact-with-COVID-19-cases-in-the-European-Union%E2%80%93second-update_0.pdf
  2. European Centre for Disease Prevention and Control (ECDC). Risk assessment guidelines for diseases transmitted on aircraft (RAGIDA). PART 2: Operational guidelines for assisting in the evaluation of risk for transmission by disease. Stockholm: ECDC; 26 Nov 2009. Available from: www.ecdc.europa.eu/en/publications-data/risk-assessment-guidelines-diseases-transmitted-aircraft-ragida-part-2
  3. Health Protection Surveillance Centre (HPSC). Epidemiology of COVID 19 in Ireland – 14 day report. Dublin: HPSC; 14 Oct 2020. Available from: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/surveillance/covid-1914-dayepidemiologyreports/COVID-19_14_day_epidemiology_report_20201014%20-%20website.pdf
  4. Linton NM, Kobayashi T, Yang Y, Hayashi K, Akhmetzhanov AR, Jung SM, et al. Incubation period and other epidemiological characteristics of 2019 novel coronavirus infection with right truncation: a statistical analysis of publically available case data. J Clin Med. 2020;9(2):538.  https://doi.org/10.3390/jcm9020538  PMID: 32079150 
  5. Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20-28 January 2020. Euro Surveill. 2020;25(5):2000062.  https://doi.org/10.2807/1560-7917.ES.2020.25.5.2000062  PMID: 32046819 
  6. Beldomenico PM. Do superspreaders generate new superspreaders? A hypothesis to explain the propagation pattern of COVID-19. Int J Infect Dis. 2020;96:461-3.  https://doi.org/10.1016/j.ijid.2020.05.025  PMID: 32422375 
  7. Lee S, Kim T, Lee E, Lee C, Kim H, Rhee H, et al. Clinical course and molecular viral shedding among asymptomatic and symptomatic patients with SARS-CoV-2 infection in a community treatment center in the Republic of Korea. JAMA Intern Med. 2020;e203862.  https://doi.org/10.1001/jamainternmed.2020.3862  PMID: 32780793 
  8. Furukawa NW, Brooks JT, Sobel J. Evidence supporting transmission of severe acute respiratory syndrome coronavirus 2 while presymptomatic or asymptomatic. Emerg Infect Dis. 2020;26(7):e201595.  https://doi.org/10.3201/eid2607.201595  PMID: 32364890 
  9. Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177-9.  https://doi.org/10.1056/NEJMc2001737  PMID: 32074444 
  10. European Centre for Disease Prevention and Control (ECDC). Transmission of COVID-19. Stockholm; ECDC; 30 June 2020. Available from: https://www.ecdc.europa.eu/en/covid-19/latest-evidence/transmission
  11. European Centre for Disease Prevention and Control (ECDC). Considerations relating to passenger locator data, entry and exit screening and health declarations in the context of COVID-19 in the EU/EEA and the UK. ECDC: Stockholm; 2020; 12 Jun 2009. Available from: https://www.ecdc.europa.eu/en/publications-data/passenger-locator-data-entry-exit-screening-health-declaration
  12. Health Security Committee Crisis management and preparedness in health. Audio meeting on the outbreak of COVID-19. Luxembourg: European Commission; 5 May 2020. Available from: https://ec.europa.eu/health/sites/health/files/preparedness_response/docs/ev_20200505_sr_en.pdf
  13. Young N, Pebody R, Smith G, Olowokure B, Shankar G, Hoschler K, et al. International flight-related transmission of pandemic influenza A(H1N1)pdm09: an historical cohort study of the first identified cases in the United Kingdom. Influenza Other Respir Viruses. 2014;8(1):66-73.  https://doi.org/10.1111/irv.12181  PMID: 24373291 
  14. Coburn BJ, Blower S. Predicting the potential for within-flight transmission and global dissemination of MERS. Lancet Infect Dis. 2014;14(2):99.  https://doi.org/10.1016/S1473-3099(13)70358-X  PMID: 24457166 
  15. Wilder-Smith A, Leong HN, Villacian JS. In-flight transmission of Severe Acute Respiratory Syndrome (SARS): a case report. J Travel Med. 2003;10(5):299-300.  https://doi.org/10.2310/7060.2003.2737  PMID: 14531986 
  16. Petersen E, Koopmans M, Go U, Hamer DH, Petrosillo N, Castelli F, et al. Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics. Lancet Infect Dis. 2020;20(9):e238-44.  https://doi.org/10.1016/S1473-3099(20)30484-9  PMID: 32628905 
  17. Ng O-T, Marimuthu K, Chia P-Y, Koh V, Chiew CJ, De Wang L, et al. SARS-CoV-2 Infection among Travelers Returning from Wuhan, China. N Engl J Med. 2020;382(15):1476-8.  https://doi.org/10.1056/NEJMc2003100  PMID: 32163698 
  18. Bae SH, Shin H, Koo H-Y, Lee SW, Yang JM, Yon DK. Asymptomatic transmission of SARS-CoV-2 on evacuation flight. Emerg Infect Dis. 2020;26(11):2705-8.  https://doi.org/10.3201/eid2611.203353  PMID: 32822289 
  19. Yang N, Shen Y, Shi C, Ma AHY, Zhang X, Jian X, et al. In-flight transmission cluster of COVID-19: a retrospective case series. Infect Dis (Lond). 2020;52(12):891-901.  https://doi.org/10.1080/23744235.2020.1800814  PMID: 32735163 
  20. Hu M, Lin H, Wang J, Xu C, Tatem AJ, Meng B, et al. The risk of COVID-19 transmission in train passengers: an epidemiological and modelling study. Clin Infect Dis. 2020;ciaa1057.  https://doi.org/10.1093/cid/ciaa1057  PMID: 32726405 
  21. Khanh NC, Thai PQ, Quach H-L, Thi NH, Dinh PC, Duong TN, et al. Transmission of SARS-CoV 2 during long-haul flight. Emerg Infect Dis. 2020;26(11):2617-24.  https://doi.org/10.3201/eid2611.203299  PMID: 32946369 
  22. Böhmer MM, Buchholz U, Corman VM, Hoch M, Katz K, Marosevic DV, et al. Investigation of a COVID-19 outbreak in Germany resulting from a single travel-associated primary case: a case series. Lancet Infect Dis. 2020;20(8):920-8.  https://doi.org/10.1016/S1473-3099(20)30314-5  PMID: 32422201 
  23. Meredith LW, Hamilton WL, Warne B, Houldcroft CJ, Hosmillo M, Jahun AS, et al. Rapid implementation of SARS-CoV-2 sequencing to investigate cases of health-care associated COVID-19: a prospective genomic surveillance study. Lancet Infect Dis. 2020;0(0):S1473-3099(20)30562-4.  https://doi.org/10.1016/S1473-3099(20)30562-4  PMID: 32679081 
  24. Nir-Paz R, Grotto I, Strolov I, Salmon A, Mandelboim M, Mendelson E, et al. Absence of in-flight transmission of SARS-CoV-2 likely due to use of face masks on board. J Travel Med. 2020;taaa117.
  25. Hoehl S, Karaca O, Kohmer N, Westhaus S, Graf J, Goetsch U, et al. Assessment of SARS-CoV-2 transmission on an international flight and among a tourist group. JAMA Netw Open. 2020;3(8):e2018044.  https://doi.org/10.1001/jamanetworkopen.2020.18044 
  26. Wilder-Smith A, Freedman DO. Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. J Travel Med. 2020;27(2):taaa020.  https://doi.org/10.1093/jtm/taaa020  PMID: 32052841 
  27. European Centre for Disease Prevention and Control (ECDC). Considerations for travel-related measures to reduce spread of COVID-19 in the EU/EEA. Stockholm: ECDC; 26 May 2020. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/Considerations-related-to-measures-for-travellers-reduce-spread-COVID-19-in-EUEEA.pdf

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