• Junfang Chen, Hanqing He, Wei Cheng, Yan Liu, Zhou Sun, Chengliang Chai, Qingxin Kong, Wanwan Sun, Jiaqi Zhang, Song Guo, Xuguang Shi, Jinna Wang, Enfu Chen, and Zhiping Chen.
• HangZhou Center for Disease Control and Prevention, Hangzhou, China.
• Travel Med Infect Dis. 2020 Jul 1; 36: 101816.

BackgroundBetween January 24, 2020 and February 15, 2020, an outbreak of COVID-19 occurred among 335 passengers on a flight from Singapore to Hangzhou in China. This study aimed to investigate the source of the outbreak and assess the risk of transmission of COVID-19 during the flight.MethodUsing a standardized questionnaire, we collected information on the travelers' demographic characteristics and illness before, during, and after the flight. We also collected data on factors potentially associated with COVID-19 transmission during the flight.ResultsA total of 16 COVID-19 patients were diagnosed among all passengers; the overall attack rate was 4.8%. The attack rate among passengers who had departed from Wuhan was significantly higher than that among those who had departed from other places. One passenger without an epidemiological history of exposure before boarding developed COVID-19. During the flight, he was seated near four infected passengers from Wuhan for approximately an hour and did not wear his facemask correctly during the flight.ConclusionsCOVID-19 transmission may have occurred during the flight. However, the majority of the cases in the flight-associated outbreak could not be attributed to transmission on the flight but were associated with exposure to the virus in Wuhan or to infected members in a single tour group.Copyright © 2020 Elsevier Ltd. All rights reserved.

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