TB and air travel

TB and air travel

During a domestic flight from Chicago to Honolulu (eight hours, 38 minutes), May 1994, a foreign-born passenger with infectious tuberculosis managed to infect four U.S.-born passengers sitting in the proximity of the patient.

This case was mentioned in The Jakarta Post, March 8, 1995, TB sufferers told to avoid air travel, and discussed in the Morbidity and Mortality Weekly Report published by the Massachusetts Medical Society, March 3, 1995, which has just been received by me courtesy of Dr. Paul W. Broadbent, American Embassy.

I bet the passenger mentioned in the article would not have been able to cause those infections had she been immediately put on chemotherapy, which is the most rapid and effective means to prevent infection.

A World Health Organization study on the infectivity of TB patients on chemotherapy since the 1950s showed that, after initiation of chemotherapy, no further infection of the disease occurred among house contacts of the infectious patients, who were treated at home, as compared with those admitted to a sanatorium.

This important finding was supported by Dr. R.L. Riley, who demonstrated that the air obtained from a TB ward, which otherwise would infect guinea-pigs, could not cause infection any longer, as soon as the patient is under chemotherapy. This finding was also confirmed by Prof. Jaques Grosset, who demonstrated that the number of "viable" bacilli in the air, produced by infectious TB patient under treatment, will immediately decrease and become too small for the transmission of bacilli.

The Morbidity and Mortality Weekly Report's editor recommended that "To prevent exposures to TB aboard aircraft, when travel is necessary, persons known to have infectious TB should travel by private transportation (i.e. not by commercial aircraft or other commercial carrier)."

My question is whether any airline could force a person who is symptomatic, but ignorant about their TB condition, to have their health checked prior to the scheduled flight?

If such a patient proves to have infectious TB, as shown by sputum microscopic examination, when would they (after how many days of chemotherapy) be allowed to travel by air? Sputum positivity for acid fast TB bacilli, after chemotherapy was started, does not imply infectiousness. Some experts would state that infectivity will disappear after the patient has received chemotherapy for a period of two weeks.

However, the biggest problem for airlines is that the passenger is consistently producing multiple drug resistant bacilli, despite prolonged treatment(s).

I wonder if the national Centers for Disease Control and Prevention (CDC), or related state health departments, are authorized to notify such cases to the airlines?

DR. MUHERMAN HARUN

St. Carolus Health Services

Jakarta