Hand-hygiene mitigation strategies against global disease spreading through the air transportation network

Christos Nicolaides; Demetris Avraam; Luis Cueto-Felgueroso; Marta C. González; Ruben Juanes

In past centuries, contagious diseases would migrate slowly and rarely across continents. Black death, for example, which was the second recorded pandemic in history after the Justinian Plague, originated in China in 1334 1 and it took almost 15 years to propagate from East Asia to Western Europe. While contagious diseases were then affecting more individuals within countries due to poor hygiene and underdeveloped medicine, the means of transportation of that era -sea and land -hindered the range and celerity of disease spreading. Nowadays in contrast, transportation means allow people to travel more often (either for business or for leisure) and to longer distances. In particular, the aviation industry has experienced a fast and continuing growth, permitting an expanding flow of air travelers. In 2017 alone, around 4.1 billion people traveled through airports worldwide 2 while the International Air Transport Association (IATA) expects that the number of passengers will roughly double to 7.8 billion by 2036 3 . Transportation hubs such as airports are therefore playing a key role in the spread of transmittable diseases 4 . In severe cases, such disease-spreading episodes can cause global pandemics and international health and socio-economic crises. Recent examples of outbreaks show how quickly contagious diseases spread around the world through the air transportation network. Examples include the epidemic of SARS (Severe Acute Respiratory Syndrome) and the widespread H1N1 influenza. SARS initial outbreak occurred in February 2003, when a guest at a hotel in Hong Kong transmitted an infection to 16 other guests in a single day. The infected guests then transmitted the disease in Hong Kong, Toronto, Singapore and Vietnam during the next few days, and within weeks the disease became an epidemic affecting over 8,000 people in 26 countries across 5 airport to a destination airport, and indicates any intermediate connecting flights (see Table 1 International Airport, Beijing, China) to HND (Haneda Airport, Tokyo, Japan), X2 individuals traveled from PEK to HND with a layover at PVG (Shanghai Pudong International Airport, Shanghai, China), and X3 individuals traveled from ATL (Hartsfield-Jackson Atlanta International Airport, Atlanta, USA) to ABV (Nnamdi Azikiwe International Airport, Abuja, Nigeria) with connecting flights at JFK (John F. Kennedy International Airport, New York, USA) and CDG (Charles de Gaulle Airport, Paris, France) airports.