SARS Transmission and Commercial Aircraft

To the Editor: Severe acute respiratory syndrome (SARS) is an emerging transmissible disease first reported in Asia in February 2003. The disease is characterized by acute onset of fever with nonproductive cough, myalgia, shortness of breath, or difficulty breathing (1). Approximately 14% of case-patients require mechanical ventilation (1,2). The syndrome is caused by the previously unrecognized SARS-associated coronavirus (SARS-CoV) (3). The primary mode of SARS transmission is through close person-to-person contact. In March 2003, the World Health Organization (WHO) issued two travel advisories to SARS-affected countries. Despite these advisories, probable case-patients traveled by air internationally, thereby spreading the disease globally. The extent of risk posed by probable cases for in-flight transmission of SARS is unclear.