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PBHE427 Epidemiology

Published : 23-Oct,2021  |  Views : 10


Review the article, Foxwell, et al. (2011) and answer the below question 

How did this investigation of influenza outbreaks on the two flights compare to the steps of an outbreak investigation noted in your readings See the two epi curves depicted, how does that type of data display help in better understanding, and perhaps planning to avoid, a similar occurrence in the future (remember our discussion on data display!)?


Review on transmission of influenza on international flights


An outbreak of H1N1 influenza and Influenza Like Illness (ILI) occurred when two flights containing total 738 passengers landed in Australia in May 2009. Within this, 43 percent of passengers took part in survey and 13 percent people had ILI during the flight. 3.6 percent of passengers had higher chance to be affected with H1N1 in future (Foxwell et al., 2011).

In this critical review of the paper by Foxwell et al. (2011), in which the transmission of influenza in international flights has been described, investigation team and resources are going to be described.

Investigation team and resources

Investigation team for this scenario was the Epi teams that works as a resource for the local health director. They work to fulfill the statutory responsibility for the investigation and respond to outbreak and other threats for the community. The resources were community nurses, disease investigation specialists, epidemiologists, physicians, consultants and case investigators (Foxwell et al., 2011).

Existence of an outbreak

This was established as the first flight chosen for the study had six passengers, who developed the signs and symptoms of H1N1 within 24 hour of boarding from the United States. Further, passengers from flight two was selected based on the passenger informations that were acquired through gathering of Health Declaration Cards and relating the cards to flight manifests acquired from the airlines (Nsoesie et al., 2014).

Diagnosis verification

Survey results, after six months of influenza outbreak were collected from the passengers. The survey asked about influenza-like indications, onset time, simultaneous conditions, antiviral prophylaxis and action, separation or confinement dates, other possible disclosure to ILI before and after the flight. The health professional present during that time was contacted to collect the health and lab reports for pandemic (H1N1) 2009 virus (Murdock et al., 2017).

Case definition

Person- acute pandemic of influenza H1N1 occurred in the passengers of two flights.

Place-In two flight from United States to Australia

Time- During May 2009 (Foxwell et al., 2011).

Line listing 

Clinical information

Demographic information

Exposure information

Clinically confirmed influenza outbreak, rapid influenza tests were positive for almost 14 percent of people who participated in survey( 43 percent of total passengers)

In the flight from the United States of America to Australia on May 24, 2009.

Nausea, vomiting, fever was present in the passengers after the onset of influenza.

Hypothesis development

It was determined from the two provided Epi curves that there were significant notifications for influenza in passengers preflight and on the day of landing in Australia, notification for pandemic on influenza was on peak. Risk of pandemic was also tested and most of the people developed ILI, however no test results are present for them. Here, the H1 was influenza positive passengers and Ho was passengers with the negative risk of influenza (Foxwell et al., 2011).

Implement control measures 

Such outbreak can occurs at any point of time anywhere; hence, the airport authority should be guided by epidemiological results of this study with environmental investigation as well. A proper balance of prevention further disease and protecting the people affected should be maintained. Isolation of the passenger infected is the most important process after the pandemic occurs (Vera et al., 2014).


In the conclusion, it can be said that this outbreak of influenza in the two flights from the United States to Australia was pandemic and the primary concern of this study was to review the process in which this pandemic was established, that has been mentioned systematically in this review article.


Foxwell, A. R., Roberts, L., Lokuge, K., & Kelly, P. M. (2011). Transmission of influenza on international flights, May 2009. Emerging infectious diseases, 17(7), 1188.

Murdock, R. C., Gallegos, K. M., Hagen, J. A., Kelley-Loughnane, N., Weiss, A. A., & Papautsky, I. (2017). Development of a point-of-care diagnostic for influenza detection with antiviral treatment effectiveness indication. Lab on a Chip, 17(2), 332-340.

Nsoesie, E. O., Brownstein, J. S., Ramakrishnan, N., & Marathe, M. V. (2014). A systematic review of studies on forecasting the dynamics of influenza outbreaks. Influenza and other respiratory viruses, 8(3), 309-316.

Vera, D. M., Hora, R. A., Murillo, A., Wong, J. F., Torre, A. J., Wang, D., ... & Loayza, L. (2014). Assessing the impact of public health interventions on the transmission of pandemic H1N1 influenza a virus aboard a Peruvian navy ship. Influenza and other respiratory viruses, 8(3), 353-359.

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