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Archived - CDC Investigation of Traveler with Multidrug-Resistant Tuberculosis (MDR TB): Questions and Answers for Passengers and Flight Crew on the Same Flight

This is an archived document. The links and content are no longer being updated.

What happened?

CDC is currently working on an investigation involving an international traveler to the U.S. recently diagnosed with multidrug-resistant tuberculosis (MDR TB). The patient with MDR TB traveled from New Delhi, India to Chicago, Illinois on a commercial flight arriving December 13, 2007. Shortly after arrival in the U.S., the patient went to a hospital for treatment.

What are the date and flight number for this investigation?

  • American Airlines # 293, departing New Delhi, India on December 12th; arriving in Chicago, Illinois on December 13th

What is CDC doing?

Shortly after being notified about the patient’s 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 and the Indian Ministry of Family Welfare to ensure notification and follow-up of passengers and crew who may have been exposed to MDR TB.

Who should be tested?

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 #293. These include:

  • passengers seated in the same row as the patient (row 35),
  • passengers seated in the two rows ahead of the patient (rows 33 and 34)
  • passengers seated two rows behind the patient (rows 36 and 37)
  • crew members working in the same cabin

These persons should receive an initial evaluation and testing for TB infection, with possible follow-up 8 to 10 weeks after the December 13 flight for re-evaluation depending on initial test results.

CDC recommends testing of these passengers and crew on the international flight from New Delhi to Chicago because this flight meets 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.

How many people were exposed to the MDR TB patient during the flight?

Forty-four passengers may have been exposed to MDR TB during American Airlines flight #293 from New Delhi, India to Chicago, Illinois.

What is the risk of acquiring TB on an airplane?

The risk of acquiring any type of TB depends on several factors, such as extent of disease in the patient with TB, duration of exposure, and ventilation. Most important, there must be someone with infectious TB disease on the same flight to present any risk.

If I was on the same flight with the MDR TB patient, can I give TB to others?

Only a person with active TB disease can transmit TB germs to others. If you have been around someone with TB disease (or MDR TB disease), you can get TB infection. However, not everyone infected with TB germs becomes sick. As a result, two TB-related conditions exist: latent TB infection and active TB disease. A person with latent TB infection cannot spread germs to other people, but can develop active TB disease in the future. People with medical conditions or on medications that suppress the immune system are at higher risk to become ill with active TB disease.

What should I do if I was seated in the affected rows on American Airlines flight 293?

If you were a passenger on the flight in question and seated in the rows specified, please contact your state TB control office, your health care provider, or CDC at 800-CDC-INFO (800-232-4636).

You should be evaluated for signs and symptoms of TB disease, and get a TB skin test or the QuantiFERON®TB Gold blood test (QFT-G) to test for TB infection. In some locations, the QFT-G test may not be available so the TB skin test may be the only option. According to CDC guidelines, either test is acceptable for testing contacts of persons with tuberculosis.

It is important to get a TB test as soon as possible. Because it can take 8 to 10 weeks after infection for your immune system to react to the TB skin test or QFT-G, you will need to get a second TB test 8 to 10 weeks after your air flight if your first test is negative.  For an explanation of what a positive test means, please see the question and answer below.

I was seated in one of the affected rows of the flight. My skin test (or QFT-G test) is positive.  What does this mean?

If your skin test (or QFT-G test) is positive, you will need to get other tests to determine if you have latent TB infection (LTBI) or active TB disease.

For someone with a positive skin test (or QFT-G), a chest x-ray should be obtained to determine if active pulmonary TB may be present. Acid-fast bacilli (AFB) smears and cultures should be performed on sputum specimens of all persons who have symptoms of TB or whose chest x-ray suggests TB.

In addition, your doctor will need to determine whether the positive test is due to infection from exposure to the MDR TB patient on the flight, or from another exposure that occurred in the past.

A number of factors will be used to make this determination. These factors include risk of previous TB exposure and whether the positive result occurred with the first skin test (or QFT-G test) or the second test (done 8-10 weeks after the airline flight with the MDR TB patient).

Related Fact:  An estimated 9.6 to 14.9 million persons residing in the United States have latent TB infection (LTBI), but are unaware since there are no signs or symptoms.

If you have never been treated for TB disease or latent TB infection, your doctor may recommend taking medications to prevent getting TB disease. Or, your doctor may recommend that you be followed with medical visits for up to 2 years such that if you should become sick with TB disease, it can be detected quickly.

The decision to provide preventive treatment or to provide follow-up exams for 2 years will in part depend on whether your doctor believes your infection resulted from exposure to the MDR TB patient or from a previous exposure to TB.  This is because preventive treatment given to persons infected by someone with regular TB disease (not drug resistant) is proven to be effective and is generally well tolerated, but preventive treatment for MDR TB may have more side effects and has not been proven to be effective.

What Is Latent TB Infection?

In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body. This is called latent TB infection.

Persons with latent TB infection do not feel sick and do not have any symptoms, but usually have a positive reaction to the tuberculin skin test (or QFT-G test). They are infected with M. tuberculosis, but do not have active TB disease.  Persons with latent TB infection are not infectious and cannot spread TB infection to others.

However, persons with latent TB infection may develop active TB disease at some time in the future. Overall, about 5 to 10% of infected persons will develop active TB disease at some time in their lives. About half of those people who develop active TB will do so within the first two years of infection. For persons whose immune systems are weak, especially those with HIV infection, the risk of developing active TB is considerably higher than for persons with normal immune systems.  Of special concern are persons infected by someone with MDR TB who later develop active TB disease; these persons will have MDR TB, not regular TB disease.

A Person with latent TB Infection (LTBI)

  • Has inactive TB bacteria in his/her body
  • Does not feel sick and is not infectious
  • Cannot spread TB bacteria to others
  • Needs treatment for latent TB infection to prevent TB disease; however, if exposed and infected by a person with MDR TB, preventive treatment may not be an option. 

The Difference Between Latent TB Infection and Active TB Disease

A Person with Latent TB Infection

A Person with Active TB Disease

  • Has no symptoms
  • Does not feel sick
  • Has symptoms that may include:
    • a bad cough that lasts 3 weeks or longer
    • pain in the chest
    • coughing up blood or sputum
    • weakness or fatigue
    • weight loss
    • no appetite
    • chills
    • fever
    • sweating at night
  • Cannot spread TB to others
     
  • Usually has a positive skin test or QuantiFERON-TB® Gold test
     
  • Has a normal chest x-ray and a negative sputum test

Where can I get additional information?

 

Last Modified: 04/18/2007

Last Reviewed: 05/18/2008
Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

 

 
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