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An outbreak of 2009 H1N1 influenza in a tour group in China during June 2009 provided an opportunity to assess spread during travel. The index case-patient, a 40-year-old woman, developed symptoms 23 hours after leaving the U.S. and just before arrival in Chengdu, China, from Hong Kong. Over the next 3 days, she flew to Jiuzhaigou and traveled with 30 other tour group members. The diagnosis of 2009 H1N1 influenza was made after she returned to Chengdu.
Chinese health authorities placed the tour members under involuntary medical observation and isolated those with symptoms or laboratory evidence of infection. They contacted all passengers on the flights originating in Hong Kong, Chengdu, and Jiuzhaigou and obtained detailed information about …