Investigation of International
Traveler with Multidrug-Resistant Tuberculosis (MDR TB)
The Centers for Disease Control and Prevention (CDC) is
working with international, state, and local health officials and other
partners on an investigation involving an international traveler to the U.S. who had recently been diagnosed with multidrug-resistant tuberculosis (MDR TB).
CDC was informed in mid-December 2007 by a local health
authority that a patient who had been diagnosed in India with MDR TB traveled
from New Delhi, India to Chicago, Illinois on December 13, 2007 on American
Airlines Flight # 293 and then on a shorter flight within
the United States. Shortly after final arrival, the patient sought treatment
for hemoptysis, fever, and chest pain at a hospital. These and other findings
indicated a potential for transmission of drug-resistant TB infection to
others. The patient has been hospitalized in
airborne isolation and is receiving treatment for TB.
Shortly after being notified about the patient and her
travels, officials of CDC’s Division of Global Migration and Quarantine
contacted American Airlines and U.S. Customs and Border Protection to obtain
the information needed to contact passengers who may have been exposed to the
traveler with tuberculosis. CDC is collaborating with U.S. state and local health departments, the Indian Ministry of Family Welfare, American
Airlines, and the Department of Homeland Security’s Customs and Border
Protection to ensure notification and follow-up of passengers and crew who may
have been exposed to MDR TB.
In accordance with the World Health Organization (WHO) TB
and Airline Travel Guidelines, CDC is ensuring appropriate follow-up and care
for persons who may have been exposed to TB on an aircraft. This includes
recommending the evaluation and testing of passengers and crew with closest
contact to the patient on board American Airlines Flight #293 departing from New Delhi, India on December 13, 2007 and arriving in Chicago, Illinois on December 13,
2007. This includes 44 passengers. These were the passengers seated in the same
row as the index patient (row 35), and those seated in the two rows ahead (rows
33 and 34) and the two rows behind (rows 36 and 37), as well as the crew
members working in the same cabin. These persons should receive an initial
evaluation and testing for TB infection, with follow-up 8 to 10 weeks after the
December 13 flight for re-evaluation.
CDC recommends testing of these passengers and crew on only
the international flight from New Delhi to Chicago because this flight was
longer than the 8 hour duration criteria specified by WHO for passenger testing
for exposure to tuberculosis. WHO and CDC do not recommend notification or
medical evaluation of passengers on briefer flights because the risk of
transmission is minimal. WHO guidelines can be found at http://whqlibdoc.who.int/hq/2006/WHO_HTM_TB_2006.363_eng.pdf
CDC issued an Epi-X notification on December 28, 2007 to
health officials in 17 states based on locating information provided by 42 of
the 44 potentially exposed passengers. (Locating information was not available
on two passengers). These states include California, Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, New Jersey, North Carolina, Ohio, Tennessee, Texas, Vermont, and Virginia. These states
should inform CDC’s Division of Global Migration and Quarantine’s duty officer
if they are unable to contact any of the passengers with destinations in their
states. The duty officer can be reached by calling CDC’s Director’s Emergency
Operation Center (DEOC) at (770) 488-7100.
Drug-susceptible (regular) TB and MDR TB are
thought to be spread the same way. The risk of acquiring any type of
TB appears to depend on several factors, such as extent of disease in
the source patient, duration of exposure, and ventilation. TB
bacilli become aerosolized when a person with TB disease of the lungs or
throat coughs, sneezes, speaks, or sings. These bacilli can float in the air
for several hours, depending on the environment. Persons who breathe air
containing these TB bacilli can become infected. Transmission has
been documented in association with patients who have TB lung disease, and
bacteria seen or cultured in sputum. Persons who become infected usually have been
exposed for several hours (or days) in poorly ventilated or crowded
environments. An important way to prevent the spread and transmission is by
limiting an infectious person’s contact with other people. Thus,
people who have suspected or confirmed TB or MDR TB that is potentially
infectious should be placed on treatment and kept isolated
until they are no longer infectious.
State and local health departments who want
additional information may contact CDC’s Division of Global Migration and
Quarantine’s duty officer through the CDC Director’s Emergency Operation Center
(DEOC) at (770) 488-7100.
Persons who believe they may have been exposed
to TB or MDR TB, or their clinicians, can call 1-800 CDC INFO for further
information.
Where to go for information about:
Tuberculosis: http://www.cdc.gov/tb/default.htm
MDR TB: http://www.cdc.gov/tb/pubs/tbfactsheets/mdrtb.htm
http://www.cdc.gov/tb/pubs/tbfactsheets/drugresistanttreatment.htm
TB Testing: http://www.cdc.gov/tb/pubs/tbfactsheets/skintesting.htm and http://www.cdc.gov/tb/pubs/tbfactsheets/QFT.htm
Infection control: http://www.cdc.gov/tb/pubs/tbfactsheets/ichcs.htm
and http://www.cdc.gov/tb/pubs/tbfactsheets/rphcs.htm
Tuberculosis and Air Travel: http://whqlibdoc.who.int/hq/2006/WHO_HTM_TB_2006.363_eng.pdf
