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